Trans Men Face Discrimination And Harassment In Healthcare Serviices

In this blog, when I've written of Transgender Experience rather than my own individual transgender experiences, I have concentrated on male-to-female transgenders.  After all, that is what I am, so that is the experience I know best.

But my own personal point of view isn't the only reason why my discussion of trans experience is so slanted. Turns out that most of the research on trans people--as little as there is--focuses on male-to-female trans people.  There are probably a number of reasons for that.  One that I can think of off the top of my head is the perception that we far outnumber female-to-male transgenders.

Now, since I don't know all of the research, what I am about to say is conjecture.  Here goes:  There probably are more MTFs than FTMs.  However, I don't think we outnumber FTMs as much as has been commonly assumed.  I think we don't hear as much about FTMs because there is, I believe, less stigma attached to a "woman becoming a man" than a "man becoming a woman", just as masculine females aren't ostracized as much as feminine males.  Also, I think that because the vast majority of violence against trans people is against MTFs--especially those of color--our struggles have become more visible than those of FTMs.

Still, violence and discrimination are committed against FTMs.  And the latter happens in an area in which we, MTFs, are all too familiar with it:  in health care. 

Wayne State University researcher Deirdre Shires and  Kim Jaffee recently co-authored a report based on a study of 1711 FTMs throughout the US in 2008-09 and recently published in the journal Health and Social Work. Most of those surveyed were aged 25 to 44 years old. Three-quarters were living full-time in their non-birth gender and a similar proportion had undergone,  or were undergoing, some medical aspect of gender transition.  

Of those surveyed, 42 percent reported some form of discrimination--ranging from verbal abuse and unequal treatment to, in a number of cases, physical assault.  The report doesn't specify which health-care professionals (doctors, nurses, technicians or others) perpetrated the discriminatory and abusive behavior against the FTMs.  

The study's authors cautioned that their findings may not apply to the entire transgender community.  Dr. Laura Erickson-Schroth, a psychiatrist with New York University may have given one reason why, though perhaps not the one the study's authors had in mind.  She says, "the sample was skewed toward white, young, college-educated people with jobs and private health insurance".  That bias is probably not the fault of the researchers, for Dr. Erickson-Schroth was describing the sort of person most likely to answer (or, in the case of the trans community, even know about) surveys like the one Shires and Jaffee conducted. 

Thus, "If 42 percent of that group is reporting discrimination, the number may be even higher for others," according to Erickson-Schroth, who edited the book, Trans Bodies, Trans Selves.

Perhaps the most disturbing finding of all is that 65 of the study's participants said they never accessed care in a doctor's office or hospital at all.  Some may do so because they don't have insurance. But a more likely explanation--and one I've heard from both FTMs and MTFs--was articulated by Shires:  "I can't help but to wonder whether they avoided care completely because they feared harassment or discrimination".  If such is the case, I can understand:  Few things feel worse than being mocked, called names or, worse, being denied care or given inappropriate care by someone who's taken a professional oath to help. I say this from a couple of experiences I had early in my transition.

The taunts and intimidation I experienced came from two nurses in a specialty hospital where I was referred. I told the receptionist I was leaving and would seek my care elsewhere.  She called a doctor, who apologized and talked encouragingly to me before performing the work for which I'd gone to that hospital.

So, my advice to any trans person who experiences discrimination or harassment is to first report it to someone in the office, clinic or hospital.  If no one is available, or no one is wiling to help, then it should be reported to an organization like the Transgender Law Center, the Transgender Legal Defense and Education Fund or the National Center for Transgender Equality.

What We Fear

From UNAIDS

A Frontier Of Transphobia In Healthcare

On the whole, I've been a bit more fortunate than other trans people in my experiences with health care providers.  I was able to find a doctor who treated many trans patients and he referred me, as needed, to others who were affirming or who, at least, cared enough only to use the right pronouns.

Still, in the early part of my transition, I had an encounter with some nasty, transphobic nurses at the New York Eye and Ear Infirmary, to which my ophthalmologist sent me.  The nurses laughed, used every derogatory term ever invented and made rude gestures.  The receptionist witnessed everything; I told her I was leaving; she summoned the doctor who talked to me in a reassuring way and promised that if I ever went there again, neither those nurses nor anyone else would treat me that way again.


A decade has passed since that incident.  Still, I think about it from time to time, especially when I hear or read about mistreatment to other trans people.  Even so, I simply can't imagine what a small but very visible group of trans people experiences.  I'm talking about pregnant trans men.

To tell you the truth, I'm not sure of how I'd react upon seeing a pregnant man. I don't think I'd make rude comments or be mean in any other way.  Still, I'm not sure I could stop myself from staring.

Knowing that, I can only imagine how it must be for them to go out in public every day, let alone deal with health care providers.  Most, I'm sure, would treat them as best they knew how.  But if some health care providers can be as mean and rude as the nurses I encountered at NY Eye and Ear, I can only imagine what it's like for those pregnant trans men.

Something That Hasn't Changed (Unfortunately)

Last night, I stopped by the LGBT Community Center.  I hadn't been there in a while, but early in my transition, I sometimes felt as if I were living there.

Anyway, I bumped into a few people I haven't seen in some time. One of them is someone I'll call Lorna.  She participated in two of the support groups I attended early in my transition.  Back then, she was still living as male but was exploring her gender identity and sexuality.  After a few other life-changing events which I won't reveal, so as not to run the risk of outing her, she recently began her transition.

I was reminded that more than a decade has passed since we attended those support groups.   A lot has changed since then, but something--disturbingly--hasn't:  Apparently, desperate trans women are still buying "German hormones" on the streets.  Someone offered them to Lorna; she refused.

 When I started my transition, it was undoubtedly easier to get hormones through legitimate means--and get the other care I needed--than it was for people who made the transition a decade before me, or the ones who transitioned a decade before them.  Still, then--as now--some trans people, especially the young, cannot access mainstream healthcare for all sorts of reasons, the most common being a lack of documentation.  Very often, young trans people are kicked out of, or run away from , their families or are bullied out of their schools and communities.  Or they are fleeing countries where they are likely to be incarcerated or murdered, sometimes by the very people who have the power to imprison them.

As long as such conditions prevail, we're still going to have lots of trans teenagers who won't make it to the third decade of their lives.  I don't think any society would stand for such a mortality rate in any other group of people.  But, as long as there are barriers to access of the improved health care, young (and sometimes not-so-young) people will continue to buy (or trade sex for) "German" hormones or other black- and gray- market substances and treatments.

When Transgenders Self-Medicate

For about nine months before I began to live and work full-time as a woman, I was taking estrogen and Spironolactone.  For about a year and a half before that, I was attending support groups and participating in various activities related to the community, some of them at the LGBT Community Center in New York City.

At a Center event, I met a trans woman who was probably a few years older than I am now.  I don't know whether or not she ever had the surgery, but it was easy to see that she'd been living for a long time as a woman--and, most likely, taking hormones.  I also suspected that she had--or might still have--been involved in sex work.

I haven't seen her in a long time, but early in my transition, I was bumping into her everywhere--or so it seemed.  She always had advice--some of it good--on some aspect or another of the life on which I was embarking.  Thankfully, I ignored what was probably the worst advice she gave me.

"Forget about the doctors, clinics, even--what's that place you go to?"

"Callen-Lorde", I said.  

"Yeah, forget about them.  Forget about all of that.  You have to go through so much to get your hormones."

"I've got them."

"But those horomones will take forever to work on you."

"Well, I am on a low dose now.  So far, so good.  As long as my next tests are good, my doctor'll up my dosage."

"Still, it's going to take years and years for them to work."

"Well, I've had to wait years to get to this point..."

"Don't you want to have a woman's body soon?"

"Yeah. But..."

"Well, I can get you some German hormones."

"German?  What's the difference?"

"Well, you know, German girls are bigger.  So they get stronger hormones."

I squinted at her.   She pulled a package from her bag.  I know a few dozen words of German, but somewhow I knew, just from looking at that label, that ingesting those hormones wouldn't be a good idea.

Later, I learned---from where or whom, I can't recall--that a lot of trans women--especially young ones engaged in sex work--buy those German hormones, which are meant for livestock.

I mention this incident because I came across this article advising trans people not to self-medicate with hormones.  Turns out, there are a lot of discussion groups about that very subject, including some on how to go about getting hormones from outside the medical establishment.

The temptation to do so is great, especially for young trans women, many of whom have run away from abuse at home or bullying at school and have no medical insurance or other resources and are scarred by prejudice and hostility they experienced from health-care professionals.

Self-medication is generally a bad idea for anybody.  But the risks are even greater for trans people because the precarious situations in which too many of us live leave us even more vulnerable to exploitation by "professionals" with questionable--or no--credentials.

That might be the biggest hazard trans people face, after the discrimination and violence to which too many of us fall victim.

 

This Letter Will Save Lives

If you were to ask most people to name a state that has progressive policies when it comes to transgender health care, many would mention California.  After all, San Francisco was one of the first cities to include gender identity and expression in its anti-discrimination laws.  It was also the first American city to offer to pay for gender-reassignment surgery, hormones and other necessary treatments for trans people who are City or County employees.

Now the California Department of Managed Health Care (CDMHC) has ordered all of the state's health plans to remove gender identity or expression as a basis for excluding or refusing coverage.

Why does that matter?  Well, I can offer one example from firsthand experience:  After I started taking hormones for two years, my doctor recommended that I get a mammogram.  My breasts had grown somewhat, but more important, the fact that I was taking estrogen put me at somewhat greater risk of breast cancer.  At the time, of course, I hadn't undergone gender reassignment surgery so, according to many insurers (though, thankfully, not the one I had) would have considered me a male.  And, as others in my situation discovered, other insurers would not pay for a "man's" mammogram--or, worse, would accuse any transwoman or her doctor of fraud for claiming the procedure.

Or, let's say some insurer considered me female and I had a medical problem that was testicular in origin, or that had to do with my prostate.  That insurer would have rejected a claim for any treatment involving those issues.

Then there are trans men who have been taking testosterone and who, perhaps, have had "top" surgery, but not bottom surgery.  He might then need, say, a pap smear--which an insurer could deny if he is classified as male.  On the other hand, if he is still classified as female, he might be denied treatment for high cholesterol or other conditions for which he is at greater risk as a result of taking testosterone.

What insurers may not realize is how risky it can be to deny treatments to people who are transitioning.  As Masen Davis, the Executive Director of the Transgender Law Center said, "This one letter will save lives."