A crowd of over 300 people including members of the state legislature and the West Hollywood City Council packed a West Hollywood auditorium on Friday, February 4 for a town hall meeting addressing issues of transgender health care.

The conflab at the Gay and Lesbian Center Village Campus was sponsored by the offices of state assembly members Jackie Goldberg, Paul Koretz, Mark Leno, and state senator Sheila Kuehl, who could not attend. Also in attendance were West Hollywood City Council members Abbe Land, Jeff Prang and Mayor John Duran.

“Transgenders experience unique barriers to accessing health care,” said Jenny Gross of the FTM (Female to Male) Alliance. Negative experiences in a medical setting, such as being laughed at by medical staff, make a patient uncomfortable and less likely to seek treatment from medical professionals in the future. Often transgender patients do not mention they are taking hormones if they are seeing a doctor to treat a cold, for example, to avoid the discomfort of a negative comment or reaction. Nearly 60% of transgenders do not discuss being transgender with their health care provider, according to a needs assessment survey by the Transgender Health Project of San Diego.

Discomfort and dissatisfaction with medical staff are not the only barriers that transgender people face. Low income is one of the largest barriers to accessing health care. About 50% of transgenders have an annual income of less than $12,000 according to a 2001 Los Angeles study of transgender health.

About two-thirds of transgenders in the study reported having no health insurance. Poverty is not the only reason transgenders lack health coverage. Some transgenders are denied insurance after they disclose their transgender status. When Lando Thomas had disclosed taking testosterone to a health insurance company, he received a letter of denial a week later. The insurer listed “gender identity disorder” as the reason for the denial. “I was just looking for basic coverage in case of an accident or if I got cancer,” said Thomas.

Having insurance does not guarantee that transgenders would have their health care needs met. Transgenders are not only denied coverage for hormones or sex reassignment procedures, but also for medical complications and for routine exams. An activist cited an example of a patient who was denied treatment for a silicone leakage from an implant received three years prior, despite the fact it could be life-threatening. Transgenders who have not fully transitioned often encounter problems when they ask for routine exams such as mammograms and pap smears, because insurance coverage only recognize one gender for these procedures.

Another issue is training of medical staff. Some continue to address the patient with a wrong gender pronoun, despite being corrected. Often doctors are ill-informed and uneducated on how to treat transgender clients’ needs, such as hormone therapy. Tracie O’Brien of the Transgender Health project of San Diego said she once saw a doctor who prescribed a hormone dosage recommended for post-menopausal women.

As a result of these barriers to health care, many transgenders resort to non-medical or “street” sources for medical needs, often putting their health at risk. In the Los Angeles study, 72% of the transgenders who inject hormones did so without medical supervision. Some inject other substances as silicone to enhance their appearance, as well.

Inadequate funding continues to plague the transgender community. Many community-based organizations receive funding for specific programs that only help a narrow spectrum of the transgender population. One example of such a organization is the Transgender Youth Consortium, which provides services for transgenders between ages 13 and 24.

Prevention case manager Alexis Rivera said, “After age 24, there are no more services. I have no place to send these women.” Furthermore, the agency has funding to only serve a caseload of 35 people. “This is inadequate because there are more than 35 transgender women in L.A. County,” says Rivera. “The waiting list can be six months to a year.”

Solutions to dealing with these frequently occurring problems of health care were suggested. Herb Schultz, former deputy director of department of managed care, said that people who are denied coverage or have complaints against insurance companies could ask for an independent medical review. The Department of Managed Healthcare offers 24-hour toll free assistance at (888) 466-2199 in over 153 languages. Another resource is the Department of Insurance, which can be reached at 1-800-927-HELP.

Sources:
Los Angeles Transgender Health Study: Community Report. May 2001.
Transgender Health Project. Family Health Centers of San Diego. 2003