This year, Brandyn Gallagher, an outspoken advocate for transgender people and a transgender man himself, found the outdated term "gender identity disorder" stamped in his medical records. "I went to a neurologist with paralysis in my hand, and not only did my paperwork say female on it, the only 'problem' listed on my paperwork was 'gender identity disorder.' That doesn't even exist and it was completely unrelated to the paralysis in my hand," he explained.
In 2013, the American Psychiatric Association (APA) replaced the stigmatizing diagnostic term "gender identity disorder" with the diagnosis of "gender dysphoria" in the revised fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). This change was made to better characterize -- without pathologizing -- the experience of identifying with a different gender than the one a person was assigned when they were born. It was a win for transgender people -- changing the definition from gender non-conformity as a mental disorder to one that better describes the stress and anxiety that may result from the experience.
"Persons experiencing gender dysphoria need a diagnostic term that protects their access to care and won't be used against them in social, occupational, or legal areas," the APA explained.
Gallagher -- who's been out as transgender for two and a half years now -- was not entirely surprised that a provider might be ignorant about how to competently treat a transgender client. "It's exhausing," he said. "I think it's pretty clear that providers largely aren't being educated about transgender issues."
He posted an image he snapped with his cell phone of the offending medical records to Twitter using the hashtag #transhealthfail, a feed filled with stunning examples of ways that transgender people have been discounted, marginalized, publicly outed -- even outright discriminated against -- in the healthcare system. One transgender woman described the time when she had to take a pregnancy test before getting a chest x-ray in spite of the fact that she, because she was born with male genatalia, did not have a uterus. "I tried explaining that there was no way I was pregnant," she wrote.
"On #transhealthfail, you'll see story after story," said Gallagher. "We have a lot of interrelated hurdles in the trans community, like employment and housing discrimination. But all of those concerns are linked to health."
This is something that Gallagher has experienced firsthand. He's been passed over for jobs he was qualified for -- finding out later that hiring personnel gave up on his file after having difficulty with the fact that his current name did not match the female name he was given at birth. He's been homeless, after unsuccessful housing searches and unnerving interviews with potential roommates.
But healthcare is his primary concern -- largely because he's seen how health can be affected by all of the other hurdles that transgender people face. "When you're homeless, you're not protected from the elements. You may be more susceptible to infections. You may be willing to do things you wouldn't normally do to stay housed. I've had sex before with a guy who had an extra room -- he was willing to let me stay, but only if I had sex with him. So I did. You can see how survival sex can be linked to criminal issues and prostitution. If you're more likely to be arrested for that, it might make employment in the future even more difficult. All these things overlap, and healthcare is the one that overlaps with them all."
Gallagher hopes that his advocacy and action in the transgender community will help to heal some of this injustice and inequality. In May, after eleven and a half years in and out of college and struggling to make ends meet, Gallagher graduated with a bachelor's degree in social psychology. In additon to working for a social service organization that helps homeless people get and maintain housing, Gallagher volunteers his time as a moderator for two health advocacy Facebook groups.
Gallagher's friend added him as a member to the PrEP Facts Facebook group in May 2014, when Gallagher began the process of getting on PrEP, pre-exposure propylaxis -- a drug regimen that is 99% effective at preventing HIV when taken daily. The popular closed-group discussion board, started by marriage and family therapist Damon Jacobs, serves as a place for people to post, question, comment on and learn about PrEP and HIV prevention. Jacobs reached out to Gallagher to become a moderator for the group after noticing that Gallagher was eagerly participating in the group and helping to consistently answer members' questions about PrEP.
"Moderating is a little like herding cats. The main thing we try to focus on is keeping everything fact-based. People can get caught up in the emotions that come with HIV and PrEP, so we want to make sure that people don't lose sight of the facts."
The group -- which now boasts more than 10,100 members -- is comprised of invested, passionate people who are excited about this new way to prevent HIV. Conversations on the board oftentimes get heated. When this happens, Gallagher and fellow moderators step in to work through issues and bring peace to the board. "We want to be the change that we want to see in the world. That means recognizing that people are doing the best they can. We will just try to keep them safe -- to work through fears and feelings, respectfully, and maintain that safe space for everyone in the process."
Inspired by the success of PrEP Facts, Gallagher recently started a spin-off Facebook group specifically for transgender men who have sex with men. He recruited an additional three moderators, and immediately saw 100 people join from PrEP Facts. An additional 100 have joined since that time.
"It's humbling. It's been incredible that guys are coming into the group and talking about things they've never been able to talk to anyone about. Maybe not even their doctors. I've seen guys talk about erectile issues. How they haven't had sex in the last ten years, because they don't know how to talk to cis[gender] guys about it. Once surgery happened, things changed, and some aren't as happy as they thought they'd be. They'll say things like, 'my body is what I want it to be, but I don't know how to navigate it. Nobody taught me how to move through the sexual world with a penis.' We actually have these conversations. Guys are starting to work through these things and go out into the world and have sex. And it's so incredible, to see people reclaim their empowerment and their sexuality."
Gallagher hopes that one day, transgender people have health care that's equal in quality to the care that cisgender men receive. Part of it, he says, will be the recognition by providers -- and the general public -- that transgender people are just normal people.
"We're functional human beings. We're not deformed, not broken, not some anomolous creature. If everyone realized this -- it would do wonders for our health care."
Brandyn Gallagher is a regular contributor to the San Francisco AIDS Foundation online blog BETA. Read his most recent articles about misogyny in fag space, better sexual health care for transgender men and PrEP for transgender men.