For Trans People, Finding Health Care Is a Constant Battle

transgender healthcare
One hundred and twenty five miles. That’s how far many of the trans people who we work with at Gender Benders in upstate South Carolina have to drive to find a medical provider who will treat them with dignity and respect. For these folks who live in places like Cowpens, S.C., a simple trip to the doctor's office often means driving to Augusta, Ga., to the Equality Clinic or Charlotte, N.C., to see someone in the Charlotte Transgender Healthcare Group. This takes about four and a half hours in the car round-trip and costs someone a whole day of work and around $25 in gas just to get to their appointment.
 
At the same time, we know there are affirming doctors who want to treat trans patients in nearly every small town across the South. So why don’t they? Why do we see this enormous gap in services for Southern rural trans folks? It’s not typically because these providers have malice or ill intent toward trans folks. Contrary to that, many providers deeply care about LGBTQ people, but they still aren’t providing hormone replacement therapy or meeting the basic needs of trans patients. This is rooted in the belief that trans folks need to see specialists in order receive care.
 
The truth is that treating a trans patient isn’t all that different from treating any other patient. I mean, sure, we’re cuter than a lot of nontransgender folks — but, if a medical provider is providing hormone therapy for polycystic ovary syndrome or low testosterone for anyone, they should also be able to provide hormone replacement therapy for trans folks.
 
We also know that trans folks see unemployment rates that are three times higher than the national average, with black trans folks facing rates that are four times higher, according to the 2015 U.S. Transgender Survey conducted by the National Center for Transgender Equality. According to the Williams Institute, an estimated 1.4 million adults in the U.S. identify as transgender, and more trans people live in Southern states than any other region of the U.S. When we add all this up it’s easy to see that for trans folks in the rural South, health care is often inaccessible.
 
This is why the Gender Benders have been offering trainings to medical providers, and working with places like the Greenville Health System, Carolina Center for Behavioral Health, and Spartanburg Regional Hospital around trans issues. Gender Benders is a grassroots organization for transgender and gender-nonconforming folks, and our friends and families. We developed a three-pronged approach to serving our people. The first leg of what we do is connecting people to the resources they need to lead full and healthy lives. The second leg is engaging in activism and education to create safer communities for our people. And the third leg is holding intentional space for people to develop relationships with other trans and gender-nonconforming folks.
 
We collaborate with doctors who specialize in working with trans folks to create resources like this insurance fact sheet that outlines helpful information about alternative coding for trans health care. The sad reality for many trans people is that we have to provide this information to our health care professionals in order to get our care coded in such a way that insurance will help offset the cost. Keep in mind, this is for those of us who are fortunate enough to even have insurance.

Another piece of this work for us is connecting people with resources like Trans in the South: A Guide to Resources and Service, which lists trans-friendly primary care providers, mental health professionals, HIV/AIDS care organizations, legal resources, and more. This helps connect people to the care they need, but it’s still not enough.

Almost 25 percent of trans people who took the U.S. Transgender Survey reported not seeking out a medical professional when they needed to see one for fear of mistreatment. A 2014 study by the Williams Institute found that 60 percent of trans people who aren’t able to find a doctor attempt suicide. Knowing this — and aware that the Trump administration is working to legalize trans health care discrimination — we cannot afford to turn a blind eye to this deprivation of resources the trans community faces when in nearly every sphere of life, but in health care particularly.

Transgender health care is primary care. We have the ability to bridge this gap and make adequate health care available for trans folks who live in the rural South. We must dispel this myth that trans care is specialty care. We must empower medical providers with resources for treating trans folks. We must make health care accessible for trans people.

Access to health care is among the most basic of human rights. Every person should have access to at least one primary care physician in their town that will treat them with dignity and respect. 

IVY GIBSON-HILL is a cofounder and the executive director of Gender Benders and serves as the LGBTQ Rights Toolkit Coordinator with Campaign for Southern Equality. Ivy lives in a small town outside of Greenville, S.C., where ze has worked as an advocate for trans, gender-nonconforming, and LGBQ people for 14 years.

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