Dr. Leonardo Candelario-Perez has worked at the three largest corporate healthcare nonprofits in Minnesota. Now they are board chair of Castor MN whose mission is to provide wellness and healthcare education to empower queer people to access the healthcare they deserve.
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After 15 years working in healthcare and advocating for queer people navigating the healthcare system, Dr. Candelario-Perez had one question, “could we create something that helps these organizations fill in the blanks that they’re not able to fill for the LGBTQI community?”
Dr. Candelario-Perez is a Latinx Boricua and bilingual clinical psychologist licensed in Minnesota. The variety of healthcare organizations they have worked in has given them unique insight into the many ways the American healthcare system engages in gatekeeping.
“I make it akin to reproductive health,” said Dr. Candelario-Perez. “In Minnesota, it is completely legal for people to get access to reproductive health, yet there are many forms of gatekeeping.”
One example is access to insurance. Another is securing care appointments. Another is navigating the personal belief system of the provider, specifically whether they will treat queer people with the same equity and dignity as non-queer people.
Much of Castor MN’s programming focuses on giving queer folks the information they need to advocate for themselves.
“Because a lot of times the healthcare providers don’t have the time to be able to appropriately assess a person’s needs,” said Dr. Candelario-Perez. “So if we give them the language and the narrative to be able to go to their providers and say, ‘This is the problem, this is the possible solution, can you help me?’ That facilitates the process for everyone.”
According to Dr. Candelario-Perez, this is crucial because the American medical system operates from a “bioessentialist medical model.” Put more simply, it reduces human problems to biology. As an example, Dr. Candelario-Perez shared how erectile dysfunction has been oversimplified as a lack of testosterone.
“Men say, ‘I have a problem with my penis,’ so I’m going to go to the penis doctor,” explained Dr. Candelario-Perez. “And then those physicians […] they want to be doing complex urological stuff. They don’t want to be talking about ED. It’s not their fault, but the simplest way to get that patient in and out of the clinic, is to give them testosterone.”
But Dr. Candelario-Perez pointed out that that doesn’t necessarily mean testing for testosterone, just simply prescribing it. They shared, “It’s bioessentialist in the sense that the medical system and the medical philosophy does not explore holistic biopsychosocial understanding of people’s healthcare.”
Dr. Candelario-Perez, who worked at the HealthPartners urology clinic for five years, joked that “if we gave out birth control, like we give out testosterone, the reproductive health issue would be solidly solved.”
Queer, Cultural, and Environmental Systems Thinking
In their attempt to address the bioessentialist medical model, Dr. Candelario-Perez shared why its necessary to engage in a variety types of thinking to unlock all the gates that model puts in front of patients.
“I think the beauty of all queer people, wherever you land in the queer spectrum is that we inherently are born into a world in which if we don’t think outside the box, it’s going to not be good for us,” said Dr. Candelario-Perez.
Another type of thinking is cultural.
“There’s a saying in Spanish that translates to you can’t ask an elm tree to give you pears,” explained Dr. Candelario-Perez. “These [healthcare] systems are elm trees. We as a community cannot be expecting a pear from them. So what can we do? We can acknowledge the value of the tree, that elm tree is doing other things in our ecosystem, but we have to go find the actual resources that are wanting to meet our needs.”
And as a self-described “animal and plant nerd,” when it came time to name Castor MN, Dr. Candelario-Perez turned to environmental systems thinking, specifically the beaver. Castor is the Spanish word for beaver.
“It’s a Minnesota state animal,” they said. “And it’s a conservation success story because we almost killed them out of Minnesota back in the 1700s. And from a biology perspective, they are both an ecosystem engineer and a keystone species. Keystone species are those that the entire ecosystem depends on and ecosystem engineers are species that manipulate their environment and thus create more environment.”
Gatekeeping Happens in Refuge States
When asked why we see gatekeeping for queer healthcare even in blue states who have passed laws protecting the LGBTQ community, Dr. Candelario-Perez first offered a clarification.
“I want to say is queer healthcare is regular healthcare,” they said. “It’s just that for some reason we decided to call it queer healthcare. It’s like hormone therapy has existed for about seven decades, but for some reason people don’t realize that.”
Regarding the barriers to healthcare in blue states, they said, “why do I still see these problems in a blue state has been a very interesting experiment for me over the last decade. I think at the end of the day, one of the biggest problems that we are not talking about in healthcare is that in the United States, healthcare is a business. It is not a right. It is a business.”
For Dr. Candelario-Perez that means until the leadership of large corporate healthcare systems understand this they won’t be able to fully realize the disproportionate impacts their business is having.
“Oftentimes when a lot of these corporations, no matter how progressive, no matter how much money they give to Pride every year, until they recognize that their business decisions are inherently discriminatory because the system is built that way, we’re not going to get anywhere,” Dr. Candelario-Perez.
They noted that since we see gatekeeping in blue states, it can be ten times worse in red states.
“But,” said Dr. Candelario-Perez, “if we have a business model that centers humanity, ethics and wellbeing as opposed to profit, then we can just pack that up and tell people this is the instructions, this is how you do it.”
To connect with Castor MN visit castormn.org.
