Dr. Jamie Buth: "I want to be this person forever"

"No matter what happens, no one can take away your goodness."

Hailing from Milwaukee, Jamie's journey to authenticity has taken her to many places, enriching her perspective. 

As a respected elder in the community, she has navigated a world that was once less informed about transgender individuals, turning her challenges into opportunities for growth. Drawing from her academic and personal insights, she uplifts and celebrates others through the transformative gender-affirming care she provides.

Today, she calls Louisiana homebase, specifically the greater New Orleans area, where she relocated for a career opportunity. Nonetheless, she continues to conduct most of her clinical work in Milwaukee.

She attended Catholic schools and quickly discerned that being drawn to feminine presentation and behavior was not condoned. It was a difficult time. It was hard to think that being who she was naturally made her repugnant in the eyes of the church and perhaps God.

She continued to hide herself. She would purge clothing often; then she would repent. However, as often as she repented, she could not change, and the cross dressing inevitably continued.

As Jamie progressed through high school to college, she tried to make sense of what was going on.

She attended Marquette University High School, an all-boys school, because her parents felt that this was the best place to develop her intellect. While there, she attempted to discuss her feelings with one of her teachers, but after an initial evaluation, nothing further was discussed.

In the late 1960s, there was absolutely nothing available as a resource to help explain her feelings and desires. This was a time prior to personal computers and the internet; knowledge was accessed in libraries through the use of card catalogue references.

She knew of no others that felt as she did or cross dressed and there were certainly no support groups.

Coping with contradictions

Having no other explanation, she initially concluded that she must be an effeminate homosexual person (this was the term used before Stonewall and the adoption of the word gay). At the time, being effeminate was a commonly accepted stereotype for all male homosexuals. Looking back, she knows now that she is bisexual, but having sex with males as a male did not interest her.

After high school, she pursued undergraduate studies at St. Louis University and continued to St. Louis University Medical School. 

In medical school, Jamie faced a challenging first marriage. She was unhappy and not fulfilled. The cross dressing continued (now using unclaimed clothing left at laundromats.) The marriage was sexless, and Jamie explored her bisexuality outside the home. She was divorced four years later, leaving her grappling with disappointment and loss.

After medical school, she entered a three-year residency in Internal Medicine. Prior to completing this, she found a loving partner in a wonderful nurse. They married and had two children and after a year teaching in St. Louis, relocated to the Milwaukee area. 

Jamie started a private practice with her partner in Muskego, WI. The practice however was extremely demanding and unfulfilling. In 1988, she left this practice and moved on to the Medical College of Wisconsin as an assistant professor of medicine. 

Despite the happiness of her marriage, Jamie continued to wrestle with her gender identity. It was difficult for her to come to grips with having the ‘perfect’ life but to still feel that she was living inauthentically. Despite her deep love for her family and her dedication to providing for them, Jamie felt an internal struggle with traditional expectations that never quite fit her.

She reflects, "I can see now that immersing myself in my career kept me from reflecting on my own feelings, but the extreme busyness of being a young doctor in a new practice also meant missing precious moments with my children." 

One poignant memory came to mind when she returned home from the hospital one Saturday morning. Her little boy, Eric, just two or two and a half years old, joyfully ran out to greet her, his excitement palpable. But then, in a heart-wrenching moment, Jamie’s pager went off. She was on call that weekend and had to quickly drive away, back to the hospital where she stayed until late. She continues to feel regret and sadness from episodes like this.

She has struggled with depression her whole life and been on medications and in therapy off and on since she was in her 20s. She was able to connect with a therapist who could talk to her about her gender identity in her 30s. And as the therapeutic relationship deepened, they began to explore her feelings and discerned that she was gendered incorrectly. Her therapist was able to find medical journal articles about people who were going through what used to call a sex change.

With therapy, Jamie found clarity in her desire to be female and present herself as such. She knew that she desired to pursue her proper gender identity. However, the trajectory that this would likely involve, including a public transition, hormones and surgery deeply scared her. It seemed to her that if she did this, she stood to lose her marriage, her children, friends, and her job. She did not think she could proceed; she felt that the potential cost was too great. So, she returned to a life outwardly as a respected male physician but internally knowing she was a transsexual (this term predates transgender).

Reflecting on this time, she found she could deal with this duality by compartmentalizing her feminine self. She was able to wall off this part of her, only accessing it when strongly drawn to it. During those moments, she would immerse herself in the feminine space, but later move away from it. However, the need to confront her feminine self was becoming increasingly pressing.

Her life continued to be complex. Jamie yearned to bring order to the chaos and find clarity. She serendipitously discovered a magazine called Tapestry, associated with a gender group in the Midwest called Renaissance. Reading this, Jamie newly recognized that it was possible to find her true self and live life as female, though assigned male at birth. This revelation was significant for her. Yet, she still faced the challenge of being married with children and having a career as a doctor. 

The essential question remained: how could she move forward, uniting her authentic self with the family life she was living?

Finally: feeling reflected

Something unexpected happened. A friend of Jamie's had to attend a conference in New Orleans, and his wife couldn't join him, so he invited Jamie. At that time, it was possible to fly using someone else’s airline ticket. Jamie embraced the opportunity to join her friend and travel to New Orleans.

As her friend engaged in the conference all day, Jamie ventured out to explore the vibrant city. She had never experienced New Orleans before and wandered through the French Quarter. She had an amazing experience in front of a club named Papa Joe’s, renowned for its welcoming atmosphere towards transgender individuals. 

She recalls,  "I can see it as if it were just yesterday. After gazing at the photographs posted outside the club, I walked in and, on entering, I encountered the club’s hostess, a stunning trans woman. Moving further into the club, I saw that all the waitresses were trans women who had somehow overcome their own barriers and were now living openly. This experience was transformative. It is hard to explain, I felt completely captivated. I was staring at them in awe." 

From that time on, she spent as much time as she could there, trying to learn their stories, and how they had gotten to be themselves.

This experience ignited in Jamie a vision of a future where she could live as her authentic self. Now in her forties, she saw that what she previously felt to be impossible could happen. A newly found hope for her life was beginning to take shape.

Of course, she wanted to return to New Orleans. In the Tapestry, she read about a trans group in New Orleans, called the Gulf Gender Society. She arranged for travel and on the next trip, she contacted the group and arranged to meet some of the members in New Orleans.

Excitement bubbled within her, but she still felt torn, caught between the eagerness to connect and the anxiety that came with taking that next step. Jamie knew that her journey had led her to this moment, yet the prospect of moving forward filled her with trepidation.

Despite her fear, she met up with Shelly and another from the group at her apartment in the French Quarter. Both members expressed themselves androgynously, neither fitting into a strictly male nor female category. As they talked, Jamie felt a sense of kindness and compassion from them, which made her feel at ease. They suggested continuing their conversation on the following evening.

Jamie recalls “the next night, we met up at a French Quarter bar. Both were fully dressed. As we coursed through the quarter, they answered the multitude of questions that I had. My questions centered on their own transitions and on the possibilities of my transitioning. I wanted to know how they overcame their barriers and what their lives were like now.” 

At the end of the evening, they invited Jamie to attend a meeting of the Gulf Gender Society, which was scheduled for the following day. They specifically invited her to come in feminine attire.

"I planned to attend that meeting no matter what. However, I had to acquire a few things. I needed an outfit, a wig, and makeup. The story of my purchasing these could be made into a comedy. Even though I desperately wanted them, each item required small, and at the time, uncomfortable, revelations of my situation."

“For example, I went into a wig store on Canal Street, but left almost immediately because there were other customers who looked my way as I entered. When I did come back, and the clerk asked what kind of wig I wanted, I realized that I hadn’t thought it out that far. I just pointed to a wig close by (basically unattractive - imagine Prince Valiant's hair style). I bought an outfit but was too embarrassed to try it on."

"I had absolutely no idea what makeup to buy. Did I need mascara, eye shadow and eye liner? Was foundation required? What was the story with blush? While I was contemplating these questions, I felt that everyone was staring at me, wondering what I was doing in the makeup department."

"Later, I went to a recommended hair stylist to style the wig. That seemed OK, but as I left to go to my car, I noticed that all the salon’s patrons were pressed to the glass windows to see this person who wanted to look female.”

When Jamie got to the Gulf Gender Society’s meeting, she was early. She brought all of her acquisitions, but Shelly was not yet there. Thankfully, Shelly arrived soon thereafter and in a separate room, told Jamie to get dressed and to put the wig on.

Then she had Jamie sit in a chair in front of the room’s mirror. 

“With my head back, Shelly and a friend worked to put makeup on me and style the wig I had bought. There I was, laying back, looking at the ceiling wondering how all of this was going to work out. When they were done, they had me sit up and look at myself in the mirror. I thought, Oh my God, oh my God this is incredible.”

In that moment, Jamie’s spirit was truly lifted. 

“Overwhelming joy flooded my heart; I felt that I could never be so happy in my entire life as I was at that moment.” It was a profound transformation, consumed by the thought, 'I want to be this forever.'"

After the meeting concluded Jamie joined some members of the group and went back to the French Quarter to have a drink at a very welcoming bar called Good Friends. 

In the car, Jamie was handed a pair of shoes with three-inch high heels.

As the group approached Good Friends after leaving the car, Jamie had the exhilarating feeling of the breeze on her face as she was fully out in public as her true self. Walking in heels was a challenge, especially on the uneven sidewalks of New Orleans, yet every step was a powerful testament to resilience.

The group gathered around a high-top table, sharing laughter and camaraderie over cold beers. When it was time for another round, her friends nudged her, saying ‘Jamie, you have to get this one’. She was terrified. She couldn’t imagine going up to a bar and speaking to people, much less ordering something. But she strode confidently to the bar, ordering drinks for the table. 

"Of course, nothing disastrous happened and it was 'joyful simply being myself.'"

A journey of highs and lows

After this amazing trip to New Orleans, it was time to return to Milwaukee and the reality of living life again as James.  Jamie was extremely depressed.

"I had ‘gone to the mountaintop’ but now had to again live my life as someone that I wasn’t.”

Back home, Jamie was able to deal with at least one major stressor in her life, her private practice. She left the practice - at some cost - and joined the medical staff of the Medical College of Wisconsin. In that setting, she was able to see patients and to teach in a markedly less stressful environment. The additional time this afforded her was very helpful.

After doing some research, she discovered an organization in Chicago that provided support. This group was called the Society for the Second Self (Tri-ess). She very much wanted to attend, but first needed to broach the subject of her gender identity with her wife. Jamie had not confided in her wife about her experiences, but knew it was something she needed to do.

This was less than smooth going. Initially, her wife had a meltdown. She was shocked and dismayed about the possibility that Jamie’s gender identity was female. She feared that her parents, who lived nearby, family and friends would find out. She was also concerned that Jamie would leave her and that their marriage might not survive. 

Filled with guilt and fearing losing her, Jamie recanted everything and entered a deeply depressed state. Later that day, Jamie’s good friend Steve, who knew everything about her, spent quite a bit of time with her wife, and after their conversations, things shifted. She seemed to better understand the situation and was more open to her attending the meetings.

She found the Tri-ess to be an interesting group. It consisted of straight males, who identified as male but enjoyed dressing as women and presenting feminine. Jamie soon made a few friends from the group. Jamie remembers the joy of going out with her friends and how liberating those moments felt. Before the Tri-ess meeting, they would rent a cheap motel room and change into their femme attire. After the meeting, they would go out together, dressed, to local gay or lesbian bars. They deeply enjoyed their time together.

Returning home to her life in Milwaukee was bittersweet. She had enjoyed her time in Chicago but found it deeply distressing to again need to present as male. Jamie's wife could sense her sadness, which she found confusing. Jamie had been able to get out and express her feminine side, but rather than being happy about it, was sad. She would express her concern, saying, “it was supposed to make you happy.” They would have arguments about the feminine clothing and how low Jamie was allowed to shave her chest.

As time went on, Jamie faced some real struggles. She knew she was different and had to find a way to live her life authentically. However, she could feel the deep sense of loss this could cause. She often doubted herself, even thinking at times of recanting her journey. The emotional weight was heavy, and Jamie questioned everything, but she knew she needed to connect with and explore her gender identity further.

Jamie's therapist at the time referred her for further assessment to a group called Pathways counseling. Pathways is a program which has been active since 1983, and has offered support for people with gender dysphoria, conflict/confusion about gender, or feeling transgender. After an extensive evaluation, it was determined that Jamie had a female gender identity and hormones were recommended. Jamie was initially taken aback by the recommendation largely through a process of self-denial. She started on the hormones - but hadn’t spoken to her wife about it.

A new day dawns

After 8 years, Jamie again returned to New Orleans. She had accepted a job at the New Orleans VA. In the months prior to starting this, Jamie confessed to her wife that
she was diagnosed with gender dysphoria and was already taking feminizing hormones. Also, that she had been undergoing facial electrolysis.

To Jamie’s surprise, her wife agreed to accompany her on the move. However, despite everyone’s best efforts, the marriage became irretrievably broken. Jamie intended to go further with her plans to accept and express her gender identity as a woman. They divorced a year after the move. She had lost her wife and, for awhile, her children.

At this point, Jamie had not yet come out at work. She continued to work at the VA as James. Her hair was long, her face smooth, and she had lost weight. Most employees just presumed that she was gay. Jamie had made plans for facial feminization surgery. She hoped to transition while on the job at the VA but knew that this would be a very high anxiety endeavor and was risky.

The director of the VA hospital and his executive assistant, both of whom were gay, played a significant role in the next step of Jamie's journey. Jamie shared her surgery plans and her need to take 10 days off afterward with the director’s assistant. Sharing that she was trans was a vulnerable moment -- but he was very supportive.

Jamie received an unexpected call at the VA from the executive assistant, a week before the surgery. She was asked to a meeting with the director and the chief of staff to discuss her transition. Her heart raced at the thought of what this meeting could mean. Initially filled with panic, she was also excited about the possibility of being out at work.

At the meeting, the director informed her that they had consulted with the American Hospital Association about her and being transgender. Even though there was still a fair amount of stigma attached to being trans, the AHA reassured VA management that being transgender was acceptable, not uncommon, and would not in any way hinder her in the performance of her duties.

Management’s plan was remarkable: after the surgery, Jamie would return to work as Jamie, fully embracing her identity as a woman. 

Jamie was overwhelmed with emotions - this was a dream come true. She would be able to be herself and keep her job. After the surgery, she returned to work as Jamie, ready to step into a new chapter of her life. Perhaps because of her hard work, her many innovations to care delivery, or because she herself was approachable and kind, the other VA staff overwhelmingly accepted her.

Throughout this time, she felt a calling to support and care for other transgender individuals. This led her to start a transgender clinic at the VA. However, it was disheartening when the Office of the Inspector General shut it down a few months later as an inappropriate use of funds (trans care, at the time, was not recognized as a VA service). Thankfully, Jamie's boss, the Chief of Staff, saw the value in the work and the need to prescribe hormone replacement. Jamie continued to care for patients in her own clinic, albeit discreetly.

Pursuing life with a passion

Life was good and Jamie's career was good. Yet, she still felt inauthentic because her transition surgery was not complete. 

Although gender affirming bottom surgery in the United States was prohibitively expensive, Jamie discovered an affordable option in Thailand. There, a vibrant trans culture flourishes, unknown to most Americans, in a place filled with kindness and positivity. She arranged for surgery and flew to Phuket, Thailand.

On waking after the surgery, she was greeted by the caring presence of four nurses in white uniforms. Jamie slowly became aware of her post surgery body. 

"I knew the transformation had taken place, and I slowly patted my body from my chest and as far down as I could reach. I knew that what had been there before was now gone and I now had the appropriate female parts. In that moment, I again felt pure joy; I was incredibly happy."

She found herself staying in Thailand longer than planned due to a complication of a second step surgery. She lost weight and strength but recovered. On the return home, she faced the challenge of feeling weak and relying on a wheelchair. Her strength gradually returned, and she felt delight with her physical transformation

Back at the VA, she continued to pursue further education. She completed a Master’s Degree in Health Care Management at Harvard University. She also entered the VA’s Executive Career Field program. She completed this in 2006 (after a delay caused by Hurricane Katrina).

She went on to become the chief of staff at a small VA hospital in Oregon. After a promising first year there, her work with regional VA management to update the facility’s mission met with substantial resistance from staff. Afterward, she returned to joyfully reclaim her old job in New Orleans as Associate Chief of Staff for Ambulatory Care. She continued in this role until retirement.

In 2014, she was able to openly begin a clinic in New Orleans to take care of transgender veterans. This was now officially sanctioned by the VA. Two years later, she was invited to also conduct a transgender clinic in Alexandria, LA.

The love of a lifetime

On return to New Orleans from Oregon, Jamie found love with an incredible woman. Their relationship included a wonderful daughter. As they built their life together, it became clear that they were destined to be together forever. In 2010, they decided to marry and traveled to Camden, Massachusetts, where same-sex marriage was legal. 

The day of their marriage was truly memorable, filled with love and acceptance. Jamie’s son and stepdaughter were present. Jamie was happy that this took place at the Harvard Faculty Club where she had intermittent membership. Because of her ongoing relationship with Harvard, a retired female Harvard dean conducted the ceremony.

While her career at the VA was very fulfilling, Jamie retired in 2020 after 24 years. She was then recruited to return to the Medical College of Wisconsin in Milwaukee for her next adventure. 

Jamie currently works at the MCW’s Inclusion Clinic, a LGBTQ program, at Froedtert Hospital. She also cares for transgender veterans at the Milwaukee VA. All her work is committed to uplifting and advocating for the LGBTQ community.

In addition to her work in Milwaukee, she also supports transgender students at Tulane University in New Orleans, both at the undergraduate and graduate levels. In addition to her knowledge and experience, Jamie can also bring the insight gleaned from her own transformative journey to assist the students.

As Jamie reflects on her remarkable life, she stands tall with accomplishments that fill her with pride. 

Being a doctor is a significant achievement for her. "I truly take pride in my ability to understand and address diverse health issues with my patients," she said.

Jamie is equally proud of her warm and loving relationship with her wife. She feels truly blessed to be with her wife, Penny, and cherishes the life they've built together and their blended family. 

"We've shared over 14 years of marriage, and as we approach our 15th anniversary, I couldn't be more grateful." 

Penny has a daughter, Sarah, whom Jamie sees as her own and considers their relationship very important.

Jamie also has two children from a previous marriage, Emily who lives in the Milwaukee metro area with Jamie’s ex, and Eric who lives in Brooklyn with his wife. Balancing these relationships can be challenging at times, but Jamie holds a deep love for each of them and strives to support her family in every way she can.

Jamie continues to be active in the trans community. Her medical practice makes a significant impact. As a teacher, she also works with young students and resident physicians exposing them to the field of transgender care. She is frequently invited to do presentations on aspects of transgender care to resident physicians, medical students, nurses and others. She recently presented to Fortunate Families, a Catholic initiative dedicated to supporting transgender individuals.

She has been a proud member of the World Association for Transgender Health Care (WPATH) for the last 30 years and has certification in WPATH’s Standards of Care Version 8. WPATH is an international organization that sets the standards for trans and gender diverse affirming care. Jamie also gets a great deal of satisfaction as a WPATH Global Education Initiative Mentor.

Embracing the past -- and the future

When Jamie reflects on her life, she embraces the rough patches as essential parts of her journey towards authenticity. 

"I'm an older person, and I've lived a wonderful life filled with the joy of raising children and having enriching experiences. I continue to learn and teach, and I find joy in the simple things, like going home to watch a movie with my wife. Life is a tapestry of moments, and I feel grateful for mine. Yet, my heart aches for the kids and adults who are now burdened by the weight of others' ignorance and anger."

Jamie expresses deep concern for the future of the queer community and the rights of trans and gender non-conforming individuals. 

"I once believed this country was just, kind, and civil, capable of resolving issues through debate and fairness. Now there is a struggle against a tide of misguided beliefs and bigotry. It’s a reminder of a dark past when queer people were openly oppressed and stigmatized.”

But even in the face of adversity, Jamie knows everyone must stand together. “The threats to healthcare access for all are serious, but we can rise above, advocate, and fight for the rights of everyone in our community."

When asked about the advice she would share, she firmly states that you need to be true to yourself. 

"You will never find contentment or happiness unless you fully embrace and celebrate who you are, regardless of what others say. I believe that is the most important lesson. I wish someone had shared that with me. And, despite the adversity and challenges, you need to always strive to be kind, considerate, and generous. Be part of the world you wish to see. It's like Gandhi said: ‘Be the change that you want to see in the world.’ This is truly important."

Jamie continues, "When it comes to current advice, it is twofold. First, be resilient. Resilience stems from your confidence in who you are and from acknowledging and embracing your worth. Know that no matter what happens, no one can take away your goodness. Stay engaged in your community because that’s how we will overcome difficult times. However, do not compromise your principles of justice, generosity, civility, and kindness along the way."

This powerful advice comes from someone who has faced adversity throughout her life yet continues to triumph.