Trans people are struggling to find decent health care -- but hope is in sight
"We see transgender folks either not being able to make a transition, or having to spend a lot of money," said Wright. "I don't know if you've ever been to a top surgery party, but they're common in San Francisco."
Mia Tu Mutch, a member of San Francisco's Youth City Services Committee who advocates for LGBTQ rights inside and outside City Hall, recently started a group that supports and raises funds for people who are transitioning.
"Me and my partner have been shocked at trans incompetency in San Francisco," said Tu Mutch. "We've had several really bad instances of doctors refusing to treat us when they found out that we were trans. There's still education needed."
Tu Mutch said that, even though she is covered by a high-quality, trans-inclusive insurance plan, she has spent at least $10,000 out of pocket on transition related expenses.
"People are usually told, 'get a good job, save all your money,'" she said. "But I've been spending 80 percent of my money on transgender related care for the past couple of years. I don't think the whole 'pull yourself up by your bootstraps' thing works."
HOPE ON THE HORIZON
But the situation is starting to change. In fact, trans organizers say that the medical, insurance and political establishments — particularly in California — are beginning to realize how backward the system is and are open to dramatic changes.
"It is an exciting time," said Dr. Dawn Harbatkin, executive director or San Francisco's Lyon Martin Health Center, which offers free and low-cost service to trans people "I didn't think I would see this during my career."
Nikki "Tita Aida" Calma, program supervisor at Trans: Thrive, echoed that sentiment. Said Calma, "I'm glad to see this in my lifetime."
Thanks to groups like Pride at Work and the Transgender Law Center (TLC), city workers in San Francisco and Berkeley are now covered by the trans-inclusive version of Kaiser's plan. The TLC, along with Lyon Martin and Equality California, came together to form Project Health in 2010, which convinced Healthy San Francisco to drop its transgender exclusions.
Tu Mutch has also worked this year to start FEATHER, or Fundraising Everywhere for All Transitions: a Health Empowerment Revolution.
Meanwhile, lawmakers in Sacramento, and even nationally, are also chipping away at the transgender discrimination that plagues the healthcare system.
Harbatkin told us that there isn't a specific set of services that make up transgender health care.
"Really good transgender medicine means that you are providing good primary care, that you're treating a patient as a whole person and taking care of all of their health care needs," she said.
Lyon Martin provides preventative care like pap smears, breast exams, and prostate exams, treatment for chronic issues like hypertension and diabetes, as well as transition-related care—services that assist transgender people in transitioning to a body that reflects their gender identity.
"The bigger part of providing good medicine is about being culturally competent, culturally sensitive," Harbatkin said. "Knowing how to address people respectfully and with their appropriate name and pronoun. Knowing about their legal name versus preferred name, or gender markers in terms of billing issues."
One obstacle transgender patients face is doctors who are unfamiliar with transition-related healthcare, such as hormone therapy and surgeries. But often, trans people are denied care that doctors know well and would perform on cisgender patients, simply because of their gender identity.
Then there's the challenge low-income people face in finding doctors who accept MediCal.
Harbatkin cited the example of an orchiectomy — surgical removal of the testicles, a procedure done by urologists. Finding a urologist who takes MediCal is fairly routine.
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