How can we improve transgender people's access to health care?
"I'm looking for the same respect and quality of care that would be given any other patient. I'm human just like everyone else." -Alexander Fuller, member of the transmen fraternity Alpha Omega Nu
Millions watched as Bruce Jenner told ABC News’ Diane Sawyer, “For all intents and purposes, I’m a woman.” Bruce Jenner is now Caitlyn Jenner. And transgender characters seem to be everywhere on TV — and celebrated for it.
Still, many people who identify as trans or gender non-conforming do not have the resources that Caitlyn Jenner has. Trans people are four times more likely to live in extreme poverty, often subsisting on less than $10,000 a year, according to a report by The National Gay and Lesbian Task Force and the National Center for Transgender Equality.
Even though transgender people are in the national spotlight, one of their most basic needs – health care – remains out of reach for many, even as demand for trans health services continues to grow.
Associate Clinical Social Worker Aydin C. Kennedy started a trans-friendly program at his South L.A. clinic at St. John’s in January 2014. At the time, they had 9 patients. When he left this January, they had just under 450.
“When I first came to L.A. I was under the impression that probably many people have: this is Los Angeles, there are probably a plethora of services,” Kennedy said. “The reality is that there’s not. And the programs that exist right now are having a hard time keeping up with the demand and have huge wait lists. It won’t be slowing down. The need is vast and big.”
On June 23, KPCC’s Leo Duran convened a panel of guests at the Los Angeles LGBT Center to discuss the barriers trans people face when trying to get the healthcare they need. We’ve rounded up a few of the issues discussed below.
- Trans people are often turned away from care. 19 percent of trans people have been denied treatment by doctors. “As a trans person and as a trans community, we've come to lower the bar of care for ourselves,” said Kennedy. “Because we are met with ‘We don’t treat you here,’ we are overjoyed when someone doesn't turn us away.”
- Doctors often don’t understand. “Gender, gender identity, and being trans is one of the few places where people still feel comfortable and justified inserting their personal opinions. It’s all too common, unfortunately,” said Kennedy. "To have to say, 'Hey I'm me, are you okay with that?' is incredibly hard to ask and opens us up to psychological trauma. It opens us up to someone saying ‘no’, which is often. And [this] greatly affects the gender dysphoria in the trans community. Personal bias has no place in a medical relationship.”
- Pushing back is exhausting and traumatic. “Coming out as trans, we tend to lose lots of family, friends. We lose more than our names and genders, we lose our whole lives,” said Alex Fuller, member of the transmen fraternity Alpha Omega Nu and the Brown Boi Project. “Long legal battles are not worth the added trauma.”
- Few referrals to places that could help. “If doctors are unwilling to provide the care for whatever reason, they should engage in some degree to connect that person with someone who does provide the care,” said Kennedy. “But that doesn’t happen. And we need to be more critical of that. We need to create celebratory care for trans people-- a model of excellence-- and not settle for low standards.”
Trans clinics taking the lead
As much of the medical establishment falters, Dr. Tisha Chere Baird said, clinics that serve trans people have been taking the lead in providing direction in how to address the mental and physical health needs of the community. Baird offered a few ways they’re raising the bar:
- Independent research. "We had one page on LGBT care in all four years of medical school. That’s it. As a health care provider, I should know what to say and what to ask, so I got on my phone and started searching." said Baird. She said she uses an educational tool called the genderbread person in training her front-facing staff.
- Training programs. "We've gone from 23 trans patients to 660 patients in the past three years at Los Angeles Medical Center since we’ve created multiple training programs with interested, trans-friendly people," said Baird. “Now there’s a list of people trained in LGBT health and if you call into our call-center to set up an appointment, you can ask for them.”
- Respecting how patients identify. "What is your preferred gender pronoun?" is a question panelist Alex Fuller loves hearing at the doctor’s office. He said that he can relax, feel comfortable, and expect to be treated with care and dignity during his visit when asked this one, simple question.
Are there other barriers you have encountered or resources available to the trans community that you would like to share? Let us know in the comments!
Tisha Chere Baird, MD: Kaiser Permanente Southern California Lead Endocrinologist for Transgender Care and an Inter-Regional LGBTI (Lesbian, Gay, Bi-sexual, Transgender, Intersex) Committee Member and Champion
Aydin C. Kennedy: Associate Clinical Social Worker in the state of California; he has been working with the queer and transgender community since 1995