Bringing Trans Rights To Healthcare by

Thomas Lick

The transgender movement is going mainstream, thanks in large part to the work of transgender activists of color – including Marsha P. Johnson, Miss Major, Bamby Salcedo and Jennicet Gutiérrez. Their efforts have helped shift perceptions of what it means to be transgender. Today, words like freak, tranny, he-she, shemale, and transvestite are no longer publicly acceptable. Transgender folks, meanwhile, are also gaining more access to protections under the law and are even seeing increasing representation in the media.

Still, there are serious challenges to ensuring that all members of the trans community have the chance to thrive, including access to quality medical care.

VoiceWaves spoke to members of Long Beach’s trans community and local medical professionals to learn about what needs to be done to improve services for transgendered patients.

There aren’t enough doctors

The last time Long Beach resident Chance Armstrong went to the hospital for a physical the doctor turned him away.

“I said I need a physical, a regular checkup for surgery,” recalls Armstrong, “and the doctor said, ‘I can’t do that because you’re trans and I don’t know trans bodies.’”

To be clear, trans bodies are not medically different from other bodies. But what Armstrong’s experience highlights is the painful lack of trained medical practitioners familiar with treating and working with trans patients.

Across California, there are only nine doctors who perform gender reassignment, or as it’s more accurately described, gender affirmation surgery.

But it isn’t just about surgery. Many trans people end up having to get drugs and hormones from the street. According to the American College of Obstetricians and Gynecologists, “More than 50 percent of persons identified as transgender have used injected hormones that were obtained illegally or used outside of conventional medical settings.”

And even in situations like the one Armstrong was in, healthcare providers are often unable to refer patients to doctors who do have experience with trans patients.

Ultimately Armstrong was able to find a doctor. Reflecting on his experience, he said some of the best nurses and doctors he’s had were the ones willing to learn and take him on as a patient.

The gender binary

On paper the medical system only acknowledges the existence of cisgender, or biological, males and females. Gender nonconformity is absent, completely. There is no box for a person who is trans male or trans female.

Naturally, this creates problems for transgender people that result in alarming disparities in how a transgendered person receives treatment.

“One of the things that has been the most challenging has been the health care system and how it relates to the needs of [transgender] patients,” says Dr. Susan Melvin of Long Beach Memorial Hospital.

As an example, she says health insurance companies will not pay for services that are only prescribed to “females” if they are already paying for services that they maintain are only necessary for “males.”

“If they go through the process of changing the information on their driver’s license and health insurance, the health insurance can’t figure it out [and will] deny care because it says that the person is male when actually they’re a transgendered person,” Melvin explains.

Drag performer Traci Russell’s experience with healthcare providers is peppered with these kinds of stories, including the time she saw a specialist assigned to remove her gallbladder.

“I was post-op at the time and I told [my doctor] that I’ve had surgery and during my exam he did this quick look down my pants.” Russell says she felt as if her doctor didn’t believe what she was telling him.

“After I called him out, he apologized and said he did this with all his patients.” But after the surgery Russell says the doctor used only male pronouns when updating her friends and family on her condition.

“There’s just some people that can’t accept it or don’t approve of it,” concludes Russell, including doctors. “And it’s like, I don’t ask for your approval. This is the way I am.”

Discrimination in the doctor’s office

For some transgender people, fear of stigma or outright hostility from health care providers is a reason not to see a doctor at all.

“Even in ‘safe’ places like transgender clinics, they still may fear discrimination or have to deal with assumptions about their health needs that aren’t fair or accurate,” said Dr. Nick Gorton, an ER physician who volunteers with the transgender clinic at LyonMartin Health Services.

The fear is not unfounded. Evidence points to health care providers often refusing to treat transgender people, solely because they are transgender.

Perhaps the most widely reported of such cases was that of Robert Eads. Over twenty doctors denied treatment for Eads, a trans man who suffered from ovarian cancer. His story was the focus of an award winning 2001 documentary, Southern Comfort. Eads eventually died in 1999, untreated.

There’s some good news…

The movement around trans rights is helping to push the conversation around fair and equal treatment forward on all fronts, including medicine.

Melvin of Long Beach Memorial admits there is still work to do to improve health access for members of the trans community, adding, however, that Long Beach has made significant gains.

“We’re behind the curve of where we need to be in medicine in general,” she says. “But Long Beach is probably one of the best regions for trans persons to access healthcare. The majority of physicians who care for patients do so without judgment.”