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No one likes the doctor’s office. Between the smell of sanitizer and nitrile gloves, the pricks of needles and the cold feeling of a stethoscope on an unprepared back, feelings of anxiety are inevitable. For transgender individuals, this feeling can multiply with anxiety surrounding whether or not they will be listened to, taken care of and generally treated with compassion.
This is something that Samwell Cleary, a neuroscience major at the university, stated he must deal with every doctor appointment as a trans man.
Cleary says discussing his trans identity with cisgender physicians regularly feels “infantalizing.” He feels that the transgender community is often referred to as a “collective other” and that individual needs can be ignored.
“I am a privileged middle class white trans man with supportive parents and insurance living in Massachusetts, one of the most advanced states in both anti-discrimination policy and healthcare,” Cleary said. “Yet still, my treatment experience as a trans person was a series of debacles founded in systemic barriers put in place to bar trans people from accessing their vital healthcare without rigorous vetting by cis people for their ‘validity,’ wealth and acceptability.”
Kelly Nichols, lead clinician and director of the Newark Planned Parenthood Gender Affirming Hormone Therapy Program, sees the product of this discrimination firsthand at work.
“I know that many trans folks experience healthcare discrimination,” Nichols said. “Because of that, I personally feel even more determined to provide a healthy, safe space for folks. I think people in general should just have a more basic understanding of really what transgender healthcare entails, what a lot of barriers are for folks and how to break down those barriers.”
One such rule that allows for such discrimination is the recent U.S. Department of Health and Human Services rollback of health care discrimination rules, announced on June 19 — amidst the COVID-19 pandemic. The National Center for Transgender Equality explains on its website that this will “eliminate the protections for transgender people experiencing discrimination in health care settings and/or by insurance companies denying transition-related care, as well as to weaken nondiscriminatory access to health care for those with Limited English Proficiency.”
Though the long-term repercussions of this rollback and the pandemic on the transgender community is yet to be seen, the effects are already being noticed, according to Rachael Richter, the gender affirming care service coordinator for Planned Parenthood in Southern Pennsylvania.
“My biggest concern is how trans and gender diverse individuals are being impacted by the pandemic,” Richter said. “Many people in our country are experiencing economic hardship, exacerbated mental health symptoms and challenging living or social situations.”
The Trump administration has removed many protections from the transgender community. This includes the elimination of sexual orientation data on foster youth and foster and adoptive parents and guardians and rejecting proposals to collect gender identity data — declaring that the federal Title IX rule requires schools to ban transgender students from participating in school sports — and rolling back protections of transgender people from discrimination by homeless shelters receiving federal funds.
“The Trump-Pence administration has shown time and again their hostility towards trans people, and their unwillingness to protect or expand access to health care,” Richter said. “These particularly unstable and challenging times make attacks on health care from the administration that much more harmful, and marginalized groups more vulnerable.”
Trans Lifeline is a trans-led organization focusing on connecting transgender people to resources they need, as well as to a peer-support hotline to aid people in crisis. The organization reported to The Washington Post that the number of calls they receive on the crisis hotline has increased by 40% since the start of the pandemic in America.
The peak volume of calls happened in the weeks following the removal of federal healthcare protection for transgender individuals.
“There’s definitely a power dynamic in healthcare offices,” Nichols said. “I think people need to know that many trans folks don’t feel comfortable going to seek health care for things that are completely unrelated to their being transgender because of discrimination and lack of education.”
In 2017, the Center for American Progress found that 29% of transgender people interviewed said “a doctor or other health care provider refused to see them because of their actual or perceived gender identity.”
Of those surveyed, 23% stated that a “doctor or other health care provider intentionally misgendered them or used the wrong name.” 21% said that a “doctor or other health care provider used harsh or abusive language when treating them. 29% said “they experienced unwanted physical contact from a doctor or other health care provider (such as fondling, sexual assault, or rape).”
Richter explained that it could get worse with the protection rollbacks, and amidst a global pandemic, the transgender community needs all the protection it can get.
“Doctors’ offices are always a place I now have to be tentative around,” Cleary said.
He explained that he has been able to access trans-friendly medical institutions, but even then it is not always perfect.
“I have had experiences where doctors in essence don’t know how to treat me,” Cleary said. “I have been deadnamed repeatedly or misgendered by people who were literally facilitating my top surgery to alleviate my dysphoria.”
The academic journal “LGBT Health” released a study explaining that Transgender Medicaid Beneficiaries (TMBs) had “more chronic conditions than CMBs (Cisgender Medicaid Beneficiaries),” including asthma and chronic obstructive pulmonary disease, despite a “greater observed proportion” of TMBs being younger than the observed portion of CMBs. Both of these conditions are listed by the Centers for Disease Control as a condition that severely increases the rate of hospitalization of COVID-19.
“After launching our teleservices at Planned Parenthood of Delaware, I actually have seen an increase in transgender patients seeking gender affirming hormone therapy,” Nichols said. “People in general actually feel really anxious about going to a health care provider’s office, and those kinds of errors are eliminated when people can be in a place where they’re comfortable.”
This connection between mental health and physical health has been seen in many communities, but the pandemic may be highlighting them within the transgender community.
Stress, according to a statement on The Cleveland Clinic’s website, “causes your body to produce greater levels of the stress hormone cortisol. In short spurts, cortisol can boost your immunity by limiting inflammation. But over time, your body can get used to having too much cortisol in your blood. And this opens the door for more inflammation … In addition, stress decreases the body’s lymphocytes — the white blood cells that help fight off infection. The lower your lymphocyte level, the more at risk you are for viruses.”
According to an article co-written by six researchers and posted through The Lancet, a general medical journal, “as a marginalized group, inequalities faced by transgender individuals in policies and social aspects, such as legislated policies based on binary gender norms, could increase the risk of illness and mortality during the COVID-19 pandemic.” These increased risks are due to the lack of specialized health-care professionals, the barriers to access healthcare for transgender individuals and gender-based violence outside of healthcare settings as well.
“These new rules threaten to undermine health care access and coverage for transgender people, as well as lesbian, gay and bisexual people, who already experience discrimination,” Richter said. “Continued rollbacks to critical protections that prevent discrimination will only further exacerbate these unacceptable statistics.”
Education, as asserted by many of these studies, is the first step toward fixing these inequalities. COVID-19 has laid bare the disparities that transgender individuals must face every day, but some, like Cleary, worry that the issues they face will not go away with a vaccine.
“In general, there is a tone of hesitation and unfamiliarity where the people that get to decide my fate in regards to my medical transition blatantly have very little knowledge about the true realities of what it’s like to be trans,” Cleary said.