HAVOQ/Pride at Work protests Kaiser at the 2012 Pride Parade.

GUARDIAN PHOTO BY YAEL CHANOFF

"But finding a surgeon who would do a vaginoplasty who accepts MediCal, that is more challenging," she said.

And some urologists might perform an orchiectomy for someone with testicular cancer — but refuse to do so for someone who is transitioning from male to female.

That type of discrimination has caught the attention of Assemblymember Tom Ammiano, and his office has been working for several years to change it.

Ammiano aide Wendy Hill has been focusing on eliminating transgender health barriers in California for years. Thanks in part to her efforts, the California Department of Insurance now interprets existing gender equity legislation to include transgender people.

"They've clarified a set of recommendations and essentially code sections that spell out that for the purpose of transgender, this law requires gender equity," Hill said. "If you cover pap smears, you have to cover them for everybody. If you cover breast reconstruction or hysterectomy, you have to cover it for everybody, regardless of gender."

Now Ammiano's office is taking on the Department of Managed Health Care and has been documenting cases of discrimination.

"When a citizen calls the Department of Managed Health Care, their helpline, they tag the call so that they know what's going on," Hill explains.

"They just tagged the calls based on discrimination. But we got them to tag the calls based on gender discrimination, and then even more specifically, discrimination against transgender people."

The sort of problem she sees: "A person goes in to be treated for what could potentially be pneumonia, but the physician is having trouble seeing this person because their papers say they're male but they are trying to see a gynecologist."

Hill said some of her most interesting moments have been outreach meetings with community members and local businesses.

"I've gone in to talk with folks and said, how many of you know someone who's transgender?" Hill recalls. "And in Sacramento, not that many people raise their hands. And then I say, how many of you identity as transgender? And the transgender people raise their hands. A lot of people don't know that they already knew transgender people."

Ammiano, who created Healthy San Francisco, said he was thrilled about the program dropping its transgender exclusions. "This has been in the works for a while," he said. "We always fully intended to make sure that everyone who needed it was covered."

Nationally, he said, "I think it's an uphill battle around eradicating the transphobia and getting services provided without any hassle, but there's light at the end of the tunnel."

SUPPORTIVE NETWORK

San Francisco offers plenty of support. Lyon Martin is part of a network of organizations providing health-related services to transgender people.

Trans: Thrive, a project of API, serves as a drop-in center for transgender people, including many who show up there as one of their first stops after coming to San Francisco to escape discrimination and danger in their hometowns. Trans: Thrive provides counseling, computer labs, food, activities, and an all-important clothing closet to cut the extensive costs of a whole new wardrobe that better reflects a person's gender identity.

Lyon Martin is "a federally qualified health center, so we take MediCal, MediCare, and many commercial insurances and Healthy San Francisco," said Harbatkin. "And for patients who are uninsured, they are put on a sliding scale based on income and family size. And we continue to see people whether they can afford it or not."

That means even people with little or no income can access transition-related surgery at Lyon Martin. This can be essential for people who otherwise would rely on MediCal.