If you believe that transgender men and women are just gay people who dress in the clothing of the opposite, you have a lot to learn. Trans men -- men whose gender at birth was female -- and trans women -- women whose gender when they were born was male -- too often have faced the difficult physical, emotional and social challenges of trying to make their minds match their reproductive organs. They also experience health and social-justice challenges that extend beyond their genitalia. Discrimination, poverty, homelessness and lack of culturally sensitive care are among the factors that contribute to the health disparities that surround this population. This is the first of a two-part series on challenges that transgender men and women face.
Inadequate health insurance coverage. Although the Affordable Care Act has opened many doors to health care access for LGBT populations, transgender men and women still encounter many obstacles to obtaining and maintaining coverage. For example, transgender people frequently experience job instability, which can interrupt health insurance coverage and increase their poverty risk as well as their risk of acquiring HIV.
States including Michigan, Texas and South Carolina allow public and private health insurers to deny coverage for gender-transition-related care. According to the Transgender Law Center, only six states -- California, Oregon, Colorado, Vermont, Connecticut, Massachusetts and Maryland -- and Washington, D.C., have explicit policies banning the exclusion of trans-specific procedures in private and state-Medicaid coverage.
Discrimination. According to a report from the National Black Justice Coalition and the National Center for Transgender Equality, Black transgender and gender-nonconforming people face some of the highest levels of discrimination in employment, housing and even obtaining health care. Even tasks such as getting a prescription for hormone replacement therapy filled can be a challenge. Fourteen states have laws that will protect a pharmacist's right to refuse to fill prescriptions if he or she has a moral or religious objection to it.
Ob-gyn Draion Burch, M.D., says that his patients who are trans women complain that getting checkups is difficult. "My thing is, whatever [genitalia] you have, check it. So I may have a trans woman who has a prostate. I advise her to get her prostate screenings. If you have a cervix, you need to get a Pap smear. If you have breast tissues, you have to get a mammogram. But my girls are having trouble finding doctors that will do the screenings. I have been called on many occasions to do a consult over the phone because the doctor just didn't want to do the checkup."
Lack of culturally sensitive care. Cancer, diabetes and cardiovascular disease are all areas of concern for trans men and women, particularly African Americans, whose disease risk is often elevated. So it's critical that physicians regularly monitor the well-being of their patients through checkups and screenings. However, a doctor's lack of respect for a trans patient can discourage patients from seeking care.
Transgender people have reported embarrassing microaggressions such as being called by their pretransition name or being mistreated while visiting their physician. Monica Roberts, a Black transgender writer and the creator of TransGriot.com, says it's not uncommon for trans people to encounter rude medical personnel. "Trans people come into doctor's offices for things besides gender-related issues: I catch colds and have fevers; I need shots," she says. "But if they're still calling me by my old name or telling me that I have to say I'm a man who has sex with men on my paperwork, then we're going to have some problems."
Check back next week to learn how factors like discrimination, poverty, homelessness and lack of culturally sensitive care increase transgender people's risk of engaging in risky behavior and the vulnerabilities that exist when hormone treatments go wrong. In the meantime, transgender people seeking physicians to attend to their unique needs can explore the website of the World Professional Association for Transgender Health, which has many resources to help trans people find health care and support. For HIV prevention help, visit the Center of Excellence for Transgender Health or check out the resources in this fact sheet from the Centers for Disease Control and Prevention.
Candace Y.A. Montague is an award-winning freelance health writer and health reporter for Capital Community News in Washington, DC.