What if I have to take off my clothes?
By Afton Bradley When a loved one is hurt our first instinct is to take them to a medical provider. As we drive them to the hospital many things run through our minds: will they be okay, is their bone broken, what if it’s not just a cold? But, when you are transgender those questions take a backseat to questions like: what gender do I put on the forms, where is safe, do I have to tell them, what if I have to take off my clothes? My name is Afton, and I am a transgender male. In addition to this, I am the trans intake counselor at Fan Free Clinic. I assist our transgender patients at the clinic and provide resources and referrals to transgender Virginians across the state. Why might you ask, do people call me from across the state looking for answers about trans-specific healthcare? The answer lies in the questions I posed above. Often when we seek care, regardless if it is related to being trans, the trans piece of our identity becomes the primary target. I am constantly asked what issues we see with the transgender community and healthcare. There are numerous statistics to cite, but I think it’s most important to highlight what I see every day. At Fan Free we provide primary care and hormone therapy to those who currently do not have health insurance and live in our geographic region. Overall, we know that transgender people are more likely to be uninsured and our patients are able to receive healthcare that is sensitive, respectful, and inclusive. However for many people in Virginia, not having insurance is most often an automatic barrier to being able to receive necessary care. Hormone therapy and transition related surgeries are often not affordable without insurance. We know access to these services is critical to improved mental health outcomes, self-acceptance, and quality of life. Even being able to change our birth certificates in Virginia to match our gender requires surgery. With surgeries costing anywhere from $20,000 to $100,000, most transgender individuals who do wish to have surgery are unable to afford the procedures. I mentioned lack of insurance is a primary barrier, but unfortunately many insurance policies do not cover transgender specific healthcare. Many of us who do have health insurance still must be able to save and pay out of pocket for our hormones and surgery. I mentioned the word necessary earlier, and it is important to know that hormones and surgery are a vital piece to many of us as we transition. Every person has a different puzzle with different pieces to affirm their gender. We need our insurance to honor these procedures as medically necessary as many insurances and organizations already have. I could continue to discuss hormones, surgery, and lack of physicians who provide these procedures, but when we put the words transgender and health together too often the language focuses only on what we do to change our bodies. Just as those who are not transgender seek medical treatment, so do we. Transgender individuals - while I wish were superheroes and often think many of us are - do get sick and injured and need access to a physician when we are in a car accident, get an infection, etc. I get a large number of calls looking for hormone therapy, but I also get calls from people looking for a safe physician. When someone is ill, the last thing that should be in their mind is am I going to be a victim of harassment or harm? However, these are validated fears as I and others have been called the wrong gender, questioned about our genitalia and bodies, or denied treatment. Every week I am left telling people I am sorry but we do not know of a provider in your area. I am also told stories that mirror ones I know too well: doctors treating us like objects, leaving mental and- in rare instances - physical scars that we cannot erase. My rural roots seem to always carry me back to Virginia, but I, just like my friends and clients, know that healthcare that is respectful of our identities, affordable, and inclusive is sporadic in this state. Laverne Cox says that “loving trans people is a revolutionary act.” I believe that for our health and well-being the medical community needs to join this revolution. This blog is part of Equality Virginia’s summer 2014 blog series on LGBT Virginians and access to insurance. Learn more about Equality Virginia's work by signing up to receive our emails! Another great way to stay in touch is by liking us on Facebook and following us on Twitter.