By Josh Katzowitz, WCI Content Director
Crystal Beal grew up in a religious family in a fairly conservative town and got married at the tender age of 20. Two decades later, Crystal—who uses they/them pronouns—lives on a completely different plane of existence, where they can live their truest life and where they help those in the LGBTQ community do the same. An existence that's so much more rewarding.
Crystal is a queer, gender-diverse person, and they’re the founder of QueerDoc, a telehealth service that, as the website states, “raise(s) the bar for gender-affirming care . . . to help guide you through making decisions about your healthcare and your body based on your gender expression goals.” Crystal sees patients who might need hormone therapy. They help those who might need mental health or surgery referrals. It’s an online-only service, and patients can interact directly with their providers while receiving an individual plan from Crystal and the other medical providers that work with QueerDoc.
And as the website states, “All our providers are SUPER-DUPER queer.”
Born and raised in Tallahassee, Crystal attended college and medical school at Florida State, where they helped found a chapter of GLMA, which focuses on education for medical school students and the community about LGBTQ health issues. They traveled to Seattle for residency, but by then, Crystal already realized that practicing primary care in the US healthcare system would lead to burnout.
“When so much of what we did in family medicine primary care was trying to help someone with chronic depression or chronic diabetes, it often felt like I was trying roll a boulder up a mountain,” they said. “What they needed was better counseling services or better access to higher quality food at a more affordable rate and the time to actually cook that food. It felt like a lot of what I was doing was beating my head against the wall against all these systemic health issues that fall into the lap of a primary care doctor, but they are so much bigger than what we can do with one patient in clinic.”
Crystal eventually worked as an associate medical director at a local hospice, took a locums family medicine job, began working on an HIV care team that was strictly done over the phone, and provided hormone treatments for transgender patients.
In 2018, they established QueerDoc, so queer, gender-diverse providers could help queer, gender-diverse patients. Even with all the pressures of setting up a new business and figuring out how to actually run it, Crystal took a part-time job at a methadone clinic so they could make ends meet.
It hasn’t been an easy road for Crystal, and the future holds student loan and potential burnout obstacles. But they said they’re happier in medicine than they’ve ever been before. Crystal has a fascinating story, and we’ve talked multiple times over the past month about their life, their business, and their future.
Here’s my conversation with Crystal, lightly edited and condensed.
Josh Katzowitz: Growing up, was there an issue for you seeing doctors? Coming out as queer, did you experience some of that stuff, where you didn’t feel comfortable with what your doctors were doing or how they were examining you?
Crystal Beal: For sure. I grew up in a super conservative, super-religious family. Everyone is a Republican. Everyone is a Southern Baptist. My grandfather was a minister. I didn’t really understand my sexuality or my gender for years. I was probably 24 or 25 when I really started to figure it out. I was married to a cis-male when I was 20, because that’s what you do in the South. We were both babies. We got divorced when I was 26. I remember I had a primary doctor while I was married. But I got divorced and had a female partner. I went to my doctor [with some vaginal symptoms] and he diagnosed and treated me for gonorrhea and chlamydia. How did I get them? I didn’t understand. A week later, I wasn’t any better. I called his office and asked for my results. I wanted to know if the tests were positive. Nobody would read me test results over the phone. I had to go back into my doctor’s office, and he pulls me into his office—not even an exam room—and says, “I’m really worried about you. When I met you, you were married. I feel like I have a professional responsibility—because you’re coming into the profession—to make sure you’re headed down the right path. I’m seeing some behaviors that are very different.” I was completely shocked. I had no idea what we were talking about and why this conversation was happening. He was a Seventh-day Adventist who was on faculty at my med school who I later rotated with.
JK: Oh jeez.
CB: He gets done with this whole lecture about my lifestyle choices, which boiled down to me having a female partner. I was there for 20 minutes getting lectured, and I was like, “OK, but the shot in my [butt] that hurt really bad didn’t fix [me].” He said, “Oh yeah, you didn’t have gonorrhea or chlamydia. You have bacterial vaginosis (BV). Here are the meds for it.” The presentation for BV is so incredibly far from the presentation of gonorrhea and chlamydia. There’s no reason he should have diagnosed me with that other than his morality. The weird thing is that gonorrhea and chlamydia aren’t common among female-female partnerships. BV is! The whole situation was such a trainwreck. It was shocking. It was 2009, and I was 26 and I was getting lectured by a physician about my lifestyle choices at my doctor’s office where he had misdiagnosed me.
JK: The guy you’re supposed to trust the most . . .
CB: Yeah.
JK: You’re part of the LGBTQ community, and you’ve been on both ends of it with the doctor-patient dynamic. You really have a sense of sympathy and empathy. I guess that probably really helps. If you’re LGBTQ and you know you need help, you might as well go to somebody who knows exactly what you’re going through.
CB: Intellectually, you could probably make that leap. It’s not going to be true for every member of a marginalized group, and it won’t be true of every provider in that marginalized group. For me, I not infrequently look for providers who are queer or queer-identify, particularly if I’m going to go with someone for mental health. As a queer-poly person, I want them to already know that and have the framework for that conversation. I know a lot of my patients feel a lot safer knowing my identity and the identity of the people who work with me.
JK: If you’re trying to get the word out, if you don’t have much money for marketing, it has to be word-of-mouth to build your practice. It has to be a different approach, right?
CB: When I first started, I tabled at a couple of Pride events and at big gender-health conferences. I did pay for some promotional materials there. But other than that, I didn’t pay for advertising. All of our social media was organic growth. All of the SEO (search engine optimization), I did myself.
JK: Your SEO game is on point. That’s how I found you.
CB: Yeah, I was working part-time. I had enough money to pay my bills. I had a supportive partner, and I let it grow really slowly. It was all word-of-mouth initially, from patients and from other providers. Now, our biggest referral service is Google search.
JK: It’s interesting, too, the idea of this sliding scale for how people are paying you. Some are paying $25 for a 45-minute appointment where you could get $300-$500 from insurance.
CB: Not anymore. It used to be $25. Now it’s $75.
JK: Haha. OK, but that’s still pretty cheap. A lot of people become doctors so they can be rich. (Uh-oh, my wife, who is a doc, is now giving me a look.) Obviously, um, they want to help the world, too. I just wonder where your mindset is with the financial aspect. How am I going to make a living? Or save for retirement? Or pay off my student loan debt?
CB: I took a huge pay cut when I left my primary care job. Getting rich was never my goal. I went into medicine to help people. I was a smart kid who had done well in school. I was studying nutrition, and I realized that I was going to graduate with a degree where I would get paid $35,000 per year. I was like, “It has to be at least $10,000 for every year I spent in school.” I started thinking about what that would look like. If I didn’t try to go to medical school, 40 years from now, I would wonder what if. Then, I got in and I was like, “Oh, I guess I have to do it.” Now I have $350,000 in debt at 6 point something percent and I was like, “Oh, maybe that wasn’t my best life plan.” . . . When I graduated and got the estimated student loan payment, I thought, “Oh, that’s comical.” . . . I didn’t want to do Public Service Loan Forgiveness. Those jobs, you can burn out. They tend to eat people up and chew them out. You have to work full-time. For me, full-time and primary care is not sustainable for my mental health. I cannot do it and stay healthy. So, I recognize I was going to have unending debt for the rest of my life, and I was going to choose having mental health and physical health as much as possible. I think the most I made in a year was $130,000. That's much less than an average full-time family med doc. When you make $130,000 a year, that $4,500 student loans payment is pretty tough. And I only made that in 2020 because I worked extra jobs in COVID consulting and telehealth urgent care to help reduce the burden on other healthcare workers. I was working 60-hour weeks in addiction medicine, with QueerDoc, and with Teladoc/Consulting.
JK: And that sounds like a lot. That’s a good salary.
CB: I’m not interested in self-destructing slowly and painfully. I’ve done that enough times in my life. I’m much more interested in a healthy version of myself. That means I can be in this field for 40 years instead of five. For me, that means working part-time. I need time to sleep. I need time to exercise. I need time to cook my food. I need time with my friends and community and my partners.
JK: Knowing you have this huge amount of debt that may never go away, you’re still able to mentally be healthy, even knowing that it’s there? Is it always going to be a balance or a push and a pull?
CB: Yeah, I think so. Sometimes, the debt is heavier on my mental health than at other times. It’s such an astronomical sum of money that it seems kind of laughable. It’s literally just gotten bigger since I left med school. It’s never gotten smaller. The first financial planner I had in residency recommended that I refinance to a private lender and declare bankruptcy. I said, “I actually don’t want to be bankrupt.” I just do income-based repayment. I’ve kept all my loan payments for forgiveness. After 25 years, I can supposedly apply for forgiveness.
JK: You just have to worry about the tax bomb.
CB: Yeah, the tax bomb and whether the program still exists. I was not very responsible with my money. I left that divorce with nothing. I went into debt to live while I was in med school. I didn’t make the wisest financial decisions, and that’s totally on me. I lived alone and didn’t have a roommate. I had two dogs to take care of. I didn’t really start saving for retirement until I was out of residency. I understood compound interest way too late.
But I will say I’ve never been happier in my career. I literally make one-third of what I made before. I’m really happy with the work I do. I never wanted to own a business. It wasn’t in my plan. I spend a lot on clothes, but I’m not a financially risky person. That sounded terrifying to me, not having a guaranteed paycheck and a match for my retirement. But I just found that I really couldn’t tolerate administrators making decisions about my patients, which is what it felt like for me.
JK: On your website, you write, “At QueerDoc, we are queer, gender diverse, trauma-informed, body-positive, sex-positive, and kink-positive.” Based on your experience with some of your doctors who were not any of that, do you see any movement in the mainstream doctor space toward that?
CB: It’s so hard to know the answer to that. A lot of the major medical organizations—AMA and AFP and the American Academy of Pediatrics—all support gender-affirming medical care. They’ve all released pieces on Trans 101 and how to be affirming, which is really great. There is definitely a move to incorporate to mainstream medical societies and their education pieces. That’s awesome. Doctors, as a whole, seem like a fairly conservative group in a lot of ways. In my personal experience, it seems more that mid-level providers tend to have more social justice stances or personal views. I don’t know how much is shifting. When I went to medical school, that was about the time we hit the 50-50 male-to-female student ratio, but before that, there were so many more cis white males in medical school than any other group. When you’re the dominant power structure, there isn’t a lot of social justice focus because it doesn’t serve you personally. That doesn’t mean you’re not a good person. You’re just not paying attention, because you don’t have to.
JK: It’s like, “Why would I ever think about that?”
CB: For your daily life, right. Now, we’re at a point where there are more females than males in med school. It’s going to be interesting to see what happens. I know there’s a push in medical schools to start incorporating more marginalized groups, to give them more slots. We know systemically Black and brown students do not have the same benefits applying to medical school that upper-middle-class white kids do. They can’t afford the testing. They can’t afford the training for the testing. They can’t afford the application. What was the quality of the education they got before that? I went to a private prep school. My dad had to spend $500 on my textbooks when I was in sixth grade. A few miles down the road at the public school, they didn’t have textbooks. Or they get them and they’re 60 years old. As a system, we have to do something to give those people a seat at the table.
But it’s such a slow shift. . . . When we really see movement is when we have providers who are personally part of a group pushing for it. We’re so personally invested, it makes us more passionate. It makes us more willing to take pay cuts that seem dumb but give us jobs that allow us to advocate for our community and push social change.
[Editor's Note: According to a 2015 survey, one in three trans-identified people did not see a doctor when needed because they could not afford it. If you'd like to make a tax-deductible donation to TransFamily Support Services, a QueerDoc partner, that can be used to help fund healthcare for trans people in need, you can do so right here. As Crystal says, “With our powers combined we could make an incredible difference.”]
Money Song of the Week
If you’re anything like me, you’re a huge fan of Iron Maiden’s discography from 1982 when vocalist Bruce Dickinson took over the singing duties until, say, 1993 when Dickinson left (and then again in 2000 when Dickinson returned). But maybe you don’t know much of the newer Iron Maiden discography from the last 15 years or so.
If that’s the case, you should hear what the song “El Dorado” (off of 2010’s “The Final Frontier”) has to say about the Great Recession of 2008. It’s certainly not my favorite Maiden song, but it did win a Grammy.
Anyway, take a listen and discover why bassist Steve Harris, the engine that has always propelled Iron Maiden forward, was apparently not such a fan of subprime mortgage lenders and mortgage-backed securities.
As the lyrics go . . .
“I'm the jester with no tears/And I'm playing on your fears/I'm a trickster smiling underneath this mask of love and death/The eternal lie I've told/About the pyramids of gold/I've got you hooked at every turn/Your money's left to burn.”
AND
“Greed, lust and angry pride/It's the same old, same old ride/The smoke and mirrors visions that you see are just like me/I'm a clever banker's face/With just a letter out of place/I know someone just like you knows someone just like me.”
AND
“So now my tale is told/Big and bad and twice as bold/This ship of fools is sinking as the cracks begin to grow/There is no easy way/For an honest man today/Which is something you should think of as my lifeboat sails away.”
Maybe this time next year, Harris and Dickinson will bless us with a song based on the soaring inflation of late 2021.
Tweet(s) of the Week
To end 2021 on a high note, I’ve got four strong tweets.
Many of the best performing growth stocks from 2020 are down in 2021…https://t.co/fE4FH3Lp05 pic.twitter.com/WAiHzVltmz
— Charlie Bilello (@charliebilello) December 13, 2021
This one …
Just saw someone describe crypto as 'Mary Kay for young men' and now I'm dying.
— Tracy Alloway (@tracyalloway) December 6, 2021
. . . pairs nicely with this one.
Is crypto just essential oils for men?
— Andy (@FrancisTheSailr) June 4, 2021
And yes, it’s OK to upgrade from one beater to another.
Lifestyle creep: In med school, I bought a new used car and upgraded to power windows and locks. Now in fellowship, I bought a new used car and it consistently starts on the first try.
— Kelly Koch, MD (@Kelly_LK86) December 9, 2021
[Editor's Note: Josh Katzowitz is the Content Director for The White Coat Investor, and his work has appeared in the New York Times, Wall Street Journal, Washington Post, Los Angeles Times, and CBSSports.com. A longtime sports writer, he covers boxing for Forbes, and his work has been cited twice in the Best American Sports Writing book series. For comments, complaints, suggestions, or plaudits, email him at [email protected]]
Thank you for sharing your story and for what you are doing. So important to increase awareness and access to care!
So great you have found a valuable largely unfilled need to provide a service for. I believe many in primary care would like to help their patients in this demographic, but need a resource for them and their patients to work with. Bravo.
Crazy how haters say this has nothing to do with finance or usual WCI fare. A physician has solved their income and burn out and social conscience concerns with a business filling a requested (needed? y’all can debate that elsewhere) service. If WCI’s new writer was only informative not scolding about Dr. Beal’s school loan repayment plan, well, they don’t want to scare away the rest of our partial success stories. If I were looking for work and was a suitable candidate I’d interview.
Speaking of requested/needed services, I guess you can pass on interviewing any docs providing remote abortion services- the secrecy needed to prevent doxing BY WCI READERS would be prohibitive (aside from legal issues lately- picture Jim subpeonaed to give up names of the sources in a Texas court).
While I applaud Dr. Beal’s efforts to help an underserved community, as a pediatrician who cares for many gender-diverse young people, I feel obliged to raise concerns about this unquestioned rush to medicalize teenagers who feel upset about how their bodies are changing at puberty which is ‘gender-affirming care’. Meaning, in some cases, breast removal and hormone injections for kids who aren’t even old enough for a driver’s license. This gets conflated with the movement for social justice and rights for gay people, but is actually quite different, with significant, long term and irrevocable implications for the questioning young people. I urge all physicians to look at the literature and educate themselves on this topic. Once place to start is segm.org.
I am not endorsing or not endorsing any org or treatments, but SEGM as an organization has been widely critiqued as transphobic. Kids (and the parents of them) who are struggling with their gender identity need to be careful of their sources of information. While there is a reasonable concern about a rush for gender blockers etc, there is also a lot of danger in those who advocate “he/she will just grow out of it”.
https://transsafety.network/posts/segm-uncovered/
1. It is not “transphobic” to advocate for the best care for gender confused young people. This is an entirely new phenomenon with a clear component of social contagion. No one is “afraid” of trans people (i.e. “transphobic), only afraid of supporting a social movement with damaging implications for future patients of ours.
2. I don’t see that SEGM has been “widely critiqued” as transphobic by anyone other than the pro-trans lobby. The link you provide is to an article by a blogger with a clear agenda. How is that considered “wide critique”?
3. There is NO danger in advocating watchful waiting, nor is anyone saying “do nothing.” Obviously people in mental distress, suffering from a DSM diagnosis, need the support and advocacy of caring clinicians. Greater awareness of ALL the issues involved, rather than suppression and attack of dissenting and concerned voices, will result in the best outcome for the greatest number of people.
As a child and adolescent psychiatrist, I share your concerns. I NEVER saw gender confusion in kids until the past 2 or 3-years. As in NEVER. And I saw lots of very odd presentations, socially taboo interests or fetishes, and every imaginable trauma. These were not kids holding back during interview. Suddenly, in these last few years, I am seeing a population of almost exclusively adolescent females–almost all of whom have struggled massively with issues of self-esteem, fitting in, abandonment and sexual trauma. I have also never had a kid or young adult come into my office and announce that their only problem was their gender identity or that none existed prior to these questions. Most of these adolescent girls will very quickly revert to identifying as females when addressing their underlying issues, and indeed, I see this regularly. I am convinced this is mostly a cultural phenomenon and can have catastrophic consequences to these kids and to society at large. I have kids tell me that they liked getting their own flag and finally fit in, that others had to respect their wishes, or that they were less likely to get raped as a reason for switching gender–none of which is rooted in any true identity but more often escapism. I consider this broader social push to unquestioning acceptance very unhealthy and potentially quite damaging to our youth, and not just those who go down this path of switching genders. Yes, perhaps the population who I see is going to lean towards having other mental health issues, but I am calling what I am seeing. Note, no where did I say these children don’t need work, but often, that help is not about acceptance, or hormones, or gender (at least not initially), but about the scarred individual who has spent a lifetime of feeling inadequate, abandoned or broken.
Well said. Glad you’re raising this point. The other day I was walking past my 12 y/o son who was on youtube and on the side bar of suggested videos, the top sponsored video was “AM I GAY?” in big bold rainbow letters. We need to be vigilant of this indoctrination by the LGBTQ community.
Well they “grew” into it didn’t they?
[Non-contributory comment removed]
[Ad hominem attack removed]
1- I’m NOT just here with popcorn for the comments which I presume from those removed are already poor reflections on the manners and humanity of a few readers, sadly possibly physicians. A huge thank you to Jim Josh and WCI for ignoring LDS and no doubt Utah norms and helping doctors (and their patients) of all genders stripes and creeds, though I joked with my partner about Jim passing this interview on to Josh. This is a website and resource which truly sees only one color, green.
2- Thank you for this interview WCI and Dr. Beal for this resource. 10 years ago I was cobbling together correct hormonal therapies for a patient who couldn’t leave rural Alabama for frequent clinic visits in Atlanta or further away. Scant websites and a few helpful docs via telephone were my lifelines. 25 years ago counseling a patient about STI treatment for her partner luckily (though no alteration in care needed) she had the gumption to correct my gender assumption about that partner. As more and more of us discover we all have friends and relations AND PATIENTS who are queer I appreciate improved health care for all of us.
This is not why I participate in WCI. What does this have to do with investing? Sad for you Jim that you allowed this extreme nonsense on a serious investing platform .
Can you just not read or skip this one article? Doesn’t seem like that big of a deal…
It’s sad when “a religious family in a fairly conservative town” has seemingly replaced “it was a dark and stormy night”. So much politics and virtue signaling everywhere you turn. WCI, I know it’s just one article, but please don’t give into societal pressure to publish this kind of stuff. We love your site for investing and money management!
You lost a reader today. This is clearly preaching wokeness as WCI virtually never ventures away from financial topics. Financial lesson of the day: Go woke, get broke.
I knew when I saw this article title that the comments would be interesting. I love the people saying (paraphrasing) ‘woke culture and cancel culture stuff is wrong. Therefore, I’m canceling you.’ Ignorance truly must be bliss.
Especially love the ‘I hate this article’ like they were forced to read it. Truly glorious. While it’s not financial, it’s your website so do whatever you want and ignore the haters. I guess to these “enlightened” people that are so much more advanced than anyone else that this means all the financial advice is now somehow nonsense.
I know you have thick skin so this will all just roll off your back and the “go woke, go broke” crowd will leave and drop your readership by 10.
I suspect WCI was approached by the LGBTQ community to have an article on their content. Dr Dahle was faced with a decision to give in and post an article promoting their agenda or risk being canceled, ostricized, deemed a x-phobic person, etc. No doubt this would be a relentless and vicious attack, like when that baker refused to bake a cake for a certain group of people and lost her business. Note the lack of commentary by the good Dr Dahle? Azrad talks about cancel culture. Those who have left WCI because of this havent canceled anything beside their subscription to a blog. When LGBTQ community cancels someone, they shut down their right to freedom of speech and any opinion which differs from their own, not only for that individual but for all others so that their point of view is completely suppressed, like when universities cancel lectures by Ben Shapiro. So lets not label dropping a subscription “cancel culture”. People like Azrad are very adept at mislabeling others for exactly what they are doing. Now, back to finances shall we?
Seriously Jim. I can no longer recommend your website to other colleagues.
Cancel culture loud and proud.
Those crypto tweets are hilarious.
This is a sincere question, as a follow up to the pediatrician mother above.
How do the writers of this article support “gender affirming care,” involving permanently changing children’s bodies and genital mutilation, even after many studies have reported between 65% to 94% of children grow out of their gender dysphoria? Anyone who has kids of their own understand that’s kids are indecisive, impressionable, and have little perspective on life and their own future. Why not err on the side of conservative, non-invasive treatment for this vulnerable population?
How many of us knew what we wanted when we were 5, 9, or even 16? How then, are these kids supposed to make “informed medical decisions” which will alter their bodies forever? What about the many adults who have come to regret the decision to undergo hormone therapy and surgery when they were younger?
I am seriously concerned about the future long term impact of these trends on these young children and their future.
As a side note, what does this have to do with the WCI blog at all? This article misses the mark, sad to see the WCI go downhill
Great article. Always good to have more docs who are not only queer, but also work towards helping that under-served population.
The consensus is currently changing regarding “Gender-affirming care. Many scientists and clinicians are coming to the viewpoint that it is generally NOT the best treatment for all young kids who are questioning their gender.
The United Kingdom court system just backed a young de-transitioning woman who sued the “gender affirming” clinic that transitioned her. She reported serious, long-term harm due to the change in biology from hormone treatment.
There is serious risk of harm to young children. The problem, as it’s painfully obvious, is that if you even ask questions, you’re labelled as TRANSPHOBIC, and risk losing your entire career, livelihood, everything.
That’s why I’m posting this anonymously, for obvious reasons.
I sincerely wish the best for the interviewee. I merely want to point out that it’s important to question this policy when there are very real-world risks to our patients if we unilaterally adopt a gender-affirming model.
2+2 = 5
WAR IS PEACE
MEN CAN GET PREGNANT
FREEDOM IS SLAVERY
NON-BINARY IS BIOLOGICAL
IGNORANCE IS STRENGTH
TRANS WOMEN ATHLETES HAVE NO ADVANTAGE
2+2 = 5
You lost a reader today. This article was “super-duper” irrelevant to white coat investing