There’s power in envisioning utopias.
The current state of health care leaves transgender and gender non-conforming people desperately underserved. For transgender patients seeking medical care, options for respectful and affirming medical providers are few and far between, much less providers who are knowledgeable in treatments and screenings that are most appropriate for trans bodies. Despite the Affordable Care Act barring discrimination based on gender identity, insurance providers still routinely deny coverage for gender-affirming treatments. This forces patients to repeatedly appeal before getting approved, which significantly delays the process. In addition, trans patients are so routinely traumatized in medical settings—being called the wrong name, referred to by the wrong pronouns, harassed by providers and clinic staff—that it has become an expectation of accessing care. This has significant and lasting consequences for trans youth’s health—33 percent of trans people have delayed getting or didn’t get preventative care because of these experiences, and 28 percent have put off getting care when sick or injured.
This is even more troubling when considering that around 41 percent of trans and gender non-conforming people have attempted suicide, compared to 1.6 percent of the general population.
Without a doubt, much more work needs to go into discussing these disparities if there is any chance of moving towards better health outcomes for transgender patients. I want to take a moment, though, to reframe the conversation. Alongside emphasizing what’s wrong with the current state of trans health care, it’s also useful to visualize what could be right—because when we imagine how health care for trans folks could look, we can start to see the roads that will take us there. Here’s my vision of a trans health utopia. What’s yours?
Knowledgeable doctors: In a 2011 study, 50 percent of survey respondents reported that they have had to teach their providers about transgender health care. In my trans health utopia, no trans person would ever encounter a medical provider who lacks the clinical experience to provide appropriate care. Instead, all doctors would have received a basic level of training that is inclusive of transgender bodies and the many different ways that people can outwardly present their genders—whether they seek medical intervention or not.
Currently there are so few doctors that are proficient in this emerging field that patients in more rural areas often have to travel quite far to see someone who is prepared (or even willing) to treat them. If transgender care were integrated into standard medical school training, there would be far more doctors to choose from, eliminating this barrier to care. This would also mean trans individuals would spend less time independently researching medical procedures or advocating for themselves in the exam room, and more time actually receiving care from an informed provider.
Furthermore, this level of knowledge should not be exclusive to the exam rooms. The entire clinic experience should be inclusive of the needs of transgender patients from the moment the patient walks in the door. This requires developing a culture where all clinic staff understand gender as a spectrum of identities and presentations, as opposed to as a strict binary of male and female. It also means developing infrastructure that is accommodating of gender variance, like more expansive gender options on paperwork and the presence of all-gender restrooms. By including these considerations in medical facilities, we create spaces where trans patients feel safe and welcome, which in turn increases patient engagement and retention.
Inclusive health insurance: I imagine what it would be like if transition-related care were recognized as simply another medical condition that demands appropriate treatment. Hormone therapy and gender-affirming surgery are recognized for being life-saving interventions. Trans individuals don’t have to go through long fights with their insurance about the necessity of their health care, or spend an undue amount of energy navigating gatekeepers and bureaucracy to prove that their needs are valid and real. Currently, transgender people are sometimes denied coverage for routine screenings because the body parts being screened are seemingly at odds with the gender listed on their health insurance. For example, some trans men need routine pap smears and other gynecological care. Truly trans-inclusive health insurance would require that patients receive coverage for the treatments that make the most sense for their bodies, not for how insurance companies think their bodies should be configured based on gender.
Model for early intervention: Trans adults currently have to bear the burden of proving without a shadow of a doubt that they are the gender that they say they are in order to access medically necessary treatments. This is only intensified for transgender youth. Medical providers often resist providing care related to transitioning, citing the possibility that the young person is too young to truly know what gender they will be later in life. What would it look like if we trusted trans kids to self-determine their genders? Puberty is an incredibly difficult time for trans youth, and patients tend to report severe anxiety and depression at the increasing division between the body they are developing and the body that aligns with their gender identity. By intervening early, we could prevent trans young people from developing permanent, unwanted secondary sex characteristics and the psychological distress that often accompanies them.
Commitment to research: One of the biggest challenges to providing care to transgender patients is that there is very little data on the topic of transgender health. I envision a world where transgender care has been studied extensively, so that providers have a wealth of knowledge to draw upon. Not only would providers have a significant body of hard data and statistics to refer to when treating patients, but more research would lay the foundation for advancements in technique and technology. Trans people’s health would be continually improving due to new innovations.
The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.
Charlie Solidum is an activist, organizer, and educator with over 10 years of experience advocating for the health care needs of the transgender community. As Linkage Coordinator for Mount Sinai Adolescent Health Center’s Project IMPACT, Charlie works to connect HIV positive young people to necessary care. Charlie also works part time as a Research Assistant with Hunter College’s HIV/AIDS Research Team doing qualitative interviews with trans masculine individuals about their sexual health. He is also a co-founder of the Tool Shed, NYC’s first and only support group for transmasculine people focusing on lower surgery.