As of 2015, Oregon has joined a few other states in covering health services specific to the needs of the transgender community. Its Medicaid now pays for hormones, puberty delay and suppression, and reassignment surgeries.
Dr. Amy Cislo, a professor of Women and Gender Studies who also teaches Transgender Studies and Gender, Religion, Medicine and Science, applauds Oregon and other states. They are, in her opinion, “trying to be progressive”. However, she says health care inequality for transgender people goes deeper than lack of access to hormones or surgeries. Even access to basic health care can be a challenge due to the medical community’s discrimination against transgender people.
“[Transgender] people will go in to the doctor with a rash, and they can’t get their rash looked at because the doctor is so focused on them being trans,” said Cislo.
Sayer Andrew Johnson, President of the Board of St. Louis’s Metro Trans Umbrella Group, a local transgender advocacy group, agrees. Though Johnson has undergone gender reassignment surgery, it is still recommended that he receive routine mammograms. He recalled a visit to a mammography clinic seven months ago as “humiliating and inappropriate.” Often, he finds, health professionals react similarly to his transgender identity.
“[The technician was] treating me as if I had some communicable disease,” said Johnson. “Even if I did, I should have been treated with more decency.” He eventually requested a different technician.
Johnson’s experience reflects a larger trend. 28 percent of respondents to a National Center for Transgender Equality (NCTE) survey reported that they had been harassed in a medical setting. Cislo believes that medical professionals do not know how to treat transgender patients while respecting their identities because most medical schools do not teach LGBT health. According to Cislo, doctors and health care workers are not trained to realize that being transgender isn’t a manifestation of disease. In fact, a startling 50 percent of NCTE survey respondents stated that they have had to “teach their medical providers about transgender care.”
The gap in knowledge about transgender health often causes uncomfortable relations between health professionals and transgender patients. Cislo recalls the experience of one of her friends, a gynecologist, who was “taken aback” when she entered the examination room and realized her patient was a transgender man. “It wasn’t that she didn’t want to help the patient,” said Cislo. “But … she was unprepared … and she knows that her relations with the patient suffered as a result.”
According to the NCTE survey, 28 percent of transgender people reported postponing medical care due to concerns about discrimination, and 19 percent report having been refused care because they were transgender. Johnson himself feels unsafe when visiting any doctor other than his primary care physician. Johnson refers transgender people to only three physicians in the St. Louis area. According to Johnson, he and other transgender people are especially reluctant to receive emergency care; they are worried about their safety at the hands of unfamiliar physicians and nurses.
Doctors are part of a larger pattern of discrimination that transgender people face. According to Cislo, transgender people have difficulty obtaining employment both because of discrimination from employers and because of legal issues. Often, transgender people cannot be legally hired because their physical appearance does not match the gender associated with their legal documents.
These forms of discrimination may seem unrelated to health care. However, almost half of NCTE survey respondents reported delaying medical care because of inability to pay. This is nearly twice the number of respondents who cited discrimination as a cause for delaying care. Compared to 14 percent of the general population, 19 percent of transgender respondents were uninsured. In this way, other forms of discrimination also prevent access to health care.
These barriers caused by discrimination, violence, and lack of education in transgender health do not just prevent access to health care; they also increase health care needs. Unemployment and low income correlate heavily with the prevalence of HIV infection, substance abuse, or suicide attempts. Respondents to the NCTE survey reported rates of HIV infection at four times the national average. A fourth of the respondents reported misusing drugs or alcohol to cope with gender-identity related discrimination. While 41 percent of respondents acknowledged attempting suicide, only 1.6 percent of the general population reports the same. Taken together, transgendered people risk falling into poor health and failing to recover.
So how can doctors and other health professionals seek to alleviate, rather than compound, the health issues faced by the transgender community? One part of the solution, believes Cislo, is that pre-health students should take courses like Trans Studies at the undergraduate level. “Knowing the history of the medical profession [when it comes to trans people], which we cover in these courses, gives insight into the many things that have been done wrong in the past and how to improve in the future,” said Cislo.
Johnson emphasizes that medical professionals should learn how to treat transgender patients from transgender people themselves. Johnson’s organization, Metro Trans Umbrella Group, offers training sessions led by transgender people. Johnson believes that experiences of transgender patients could improve if doctors take the opportunity to “hear the desires, hear the support needed, straight from the mouths of the people [they] are treating.”
Cislo suggests, however, that the first step may be simply a casual encounter. “Doctors in training would benefit just from having a conversation with someone who is trans in a non-clinical setting.”