I recently got the chance to get to know Miles Harris, one of Nurx’s newer providers. Miles is a family nurse practitioner (by way of an art degree) based in Sacramento, and he specializes in HIV prevention and transgender health.
As someone who came upon their career path via a very winding road (I’m a sex educator with an undergraduate degree in literature), I love getting to know how other folks find their way into the human sexuality and sexual health fields.
During our conversation, Miles and I spoke about the “what am I even doing” moments that happen after you graduate from college, how sexual health and trans health are covered in nursing programs, and about how trans folks can more safely and confidently access affirming healthcare services. We also spent time talking about cats and their (lack of) manners during video calls, home office decor, and the importance of having mentors who you connect with. All that to say — we covered a lot, so this interview is shortened for length and clarity.
Nurx community, I’m delighted to introduce you to Miles Harris.
You previously went to school for art and biology before going back to study nursing. What compelled you to make that switch?
After I graduated (the first time), I worked in a role with many performance artists. Everybody was so talented, but still struggling to make ends meet. On top of their artist jobs, they were baristas and servers — I knew that I wanted and needed a little more stability than that. At the same time, those artists who were working so hard also didn’t have health insurance and really didn’t have access to healthcare services.
I had always been interested in healthcare as a potential career, so eventually, that’s where I found myself. I had been interested in midwifery for a while, but that didn’t feel like quite the right fit. Now I’m a family nurse practitioner, so it’s a wider spectrum of care, even though sexual health is a big focus of mine.
When you were in nursing school, was trans care covered at all?
Well, the first time I was in nursing school (for my BSN), it all happened so fast — I honestly don’t remember a lot of specifics! BSN programs generally don’t focus on prescribing — it’s more care-oriented. In the curriculum, there were some small sections on diversity, but nothing truly landmark.
There were, however, student activists in the nursing program who were advocating for queer and trans issues to be covered more. All nurses are pretty cool, but I think the people who choose to go back to school a second time for nursing tend to be really radical and focused on inclusivity.
In my master’s program, I had a mentor who firmly advocated for the inclusion of queer and trans health in the program. She had a noticeable impact, and so our curriculum had more coverage of queer and trans health issues.
How has access to trans-affirming healthcare changed from the start of your career to now?
It’s changed a lot. Language has shifted, but so has access. I started my nursing career in Philadelphia (during my BSN) and then I worked in New York, and care was really dependent on just a few health centers. Now, there are simply more LGBTQ+ health centers and providers more broadly are knowledgable about queer and trans health needs.
We still have progress to make — and so many of those programs need more financial and staff support — but it’s happening. Sometimes it’s hard to see the long game because I’m so in it every day.
Right now, people might be dealing with a waiting list or hours-long drives just to see providers who are willing to prescribe hormones. I think that’s where telemedicine can have a big impact. When I thought about the trajectory of my career, I didn’t necessarily think “Ah, telemedicine, of course” but it’s been really interesting. A lot of trans people still struggle to access services like hormone therapy, and it would be a dream to have that barrier be reduced by telemedicine.
Most medical providers don’t learn about trans-affirming care and some might feel like trans healthcare is only relevant to sexual health providers and endocrinologists. What are some lessons you would want all healthcare providers to learn about working with trans patients?
One big thing is that hormone therapy isn’t contraception. We don’t have a ton of research on this, but we do know that it’s possible — even if that possibility is reduced — for a transmasculine person taking testosterone to get pregnant and for a transfeminine person taking estrogen to potentially get somebody pregnant. So, don’t assume that pregnancy prevention is automatically taken care of; talk with your patients about their contraceptive options.
On the other side of that, there’s the fertility issue. Again, there isn’t a ton of research here, but what we do know seems to point to the possibility that transmasculine people who have taken testosterone who decide they want to become pregnant — they could. On the flip side, research is a little murkier on if transfeminine people who produce sperm will still produce viable sperm after taking hormones. It’s important to talk to your patients about their fertility preservation options and make sure that they’re informed. Not many people who take hormones opt for some type of fertility preservation, because honestly, it’s incredibly expensive. But it’s necessary to make sure people know that those options exist.
And finally — and this isn’t specific to trans patients necessarily — that HIV prevention and treatment is so much easier than it has ever been before. Medications for HIV management are much more streamlined, and PrEP is a very simple option for HIV prevention.
Seeking out healthcare can be a stressful experience for trans people. What are some things patients can keep an eye out for when they’re looking for an affirming provider?
If you have a network of trans and queer friends, word of mouth is going to be the most helpful tool here. Which providers do people in your community see and recommend? Who do they not recommend? Many major cities also have Facebook groups dedicated to transgender resources and community building, and those will often include provider recommendations.
Then, check their website. To be clear, the doctor or nurse you’ll be seeing is almost certainly not the person who designed the website, but it can give you a feel for their practice. What language do they use? Is it outdated or affirming? Some practices also have social media profiles, and seeing what content is posted there can give you a sense of the practice’s values and attitudes.
It’s common for folks to get nervous once their appointment starts, and if you’re feeling nervous, you might not remember everything you wanted to talk about. Before your appointment, write down the questions you have. That can help keep you on track and make sure you get answers to the questions that you most want to ask. You can also bring a trusted friend with you — just make it clear what you’re asking of them. Do you just want a friendly face in the exam room to help you stay relaxed? Do you want them to bring up a question you had if you forget to ask it?
Nurx doesn’t prescribe gender-affirming hormones at this time, but we do provide care for transgender and gender non-binary people in our current services, like birth control and emergency contraception, PrEP, STI and HPV testing, and migraine treatment. If you’re transgender or non-binary and seeking support — or if you’re just look for an amazing organization to donate to — check out Trans Lifeline. It’s a nonprofit, grassroots hotline that offers both emotional and financial support for trans people in crisis. It’s run for the trans community, by the trans community.
This blog provides information about telemedicine, health and related subjects. The blog content and any linked materials herein are not intended to be, and should not be construed as a substitute for, medical or healthcare advice, diagnosis or treatment. Any reader or person with a medical concern should consult with an appropriately-licensed physician or other healthcare provider. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of Nurx™.