Living Columns & Blogs

Transgender community faces unique challenges in access to health care

The transgender community has become quite the subject of several discussions in recent months. Especially with public figures, such as Caitlyn Jenner and actress Laverne Cox, making headlines.

We hear about identity and cultural issues, and some of the social struggles these individuals face on a day-to-day basis. But we hear less about their health concerns, and about the barriers trans-identified people have to cross to access medical care and support services.

It’s no secret that there are emotional, mental and physical health concerns that come with struggling to understand one’s own gender identity. But these concerns can be eased when resources and acceptance are made available in one’s own community.

Transgender people living in rural areas or smaller cities often do not have access to physicians and specialists who have the knowledge to serve their needs.

They travel to bigger cities for medical care. Or, worse, they delay medical attention.

I recently learned that it is not rare for transgender people in Merced or other San Joaquin Valley communities to travel to the Bay Area in search of endocrinologists for hormone treatments. Many times, primary care doctors are also sought in these areas where communities are “more accepting” of transgender people.

TransVision, for example, is a program out of the TriCity Health Center in Alameda County that specializes in addressing medical issues for the transgender and transsexual communities.

The clinic offers primary care services as well as hormone assessments, HIV care and treatment, and screenings for sexually transmitted diseases.

According to Tiffany Woods, program coordinator of TransVision, the center sees patients from all across the valley, Northern California and Oregon. She estimates that in the past year, the program has seen about 330 people for primary care.

The need for trans-affirming and culturally responsive providers very much exists, Woods said. She believes that the lack of physicians who have done their homework on trans-issues is what keeps driving people to TransVision.

A big hurdle the trans community has had to overcome is dealing with insurance companies. Most insurance providers consider being transgender a pre-existing condition, and as we all remember, prior to the Affordable Care Act, most insurances would not cover expenses related to these pre-existing conditions.

By law, insurance companies are now required to cover trans-related care. But the stigma is still there.

Woods explained that there are still many clients, especially young adults, who will pay out of pocket because they fear that anyone on their insurance plan will find out.

The scarcity of local resources is a setback for the transgender community. Earlier this month, the LGBT center in Merced, which provided a safe space for many, closed its doors and the possibility of a reopening is still in discussion.

But the lack of these safe spaces is not the only reason why transgender people may choose to seek help outside their county.

Leslie Ewing, executive director of the Pacific Center for Human Growth in Berkeley, said that people going through a transitional period often seek discretion – something that is not always promised in their smaller hometown.

“That assurance of anonymity is worth the extra 40 to 50 miles,” she said.

The Pacific Center for Human Growth offers mental health and peer help services. About 90 percent of the people who visit the center are from the LGBTQ community, Ewing explained, and it is not rare to get visits from people who live in smaller or rural towns.

But their being transgender or gay is not necessarily why people go to the center, Ewing said. Most of the time, they are just going through a transition in life, such as a break-up.

Either for support or medical services, people will go where they feel comfortable. “And you feel most comfortable where there are people like you,” Ewing said.

Here is some data to keep in mind:

▪ According to the National Center for Transgender Equality, trans-identified people report having to jump several hurdles to access care.

▪ Forty-one percent of transgender people reported postponing medical care because of an inability to pay, while 28 percent postponed care because of their fear of anti-trans bias in a health care setting.

▪ The center also found that a quarter of the transgender people surveyed reported that they had been harassed or disrespected in a hospital or doctor’s office.

▪ It is estimated by the National LGBT Health Education Center that 62 percent of transgender people have experienced depression and 41 percent admit to having attempted suicide.

▪ The rate of HIV infection among the trans community is 2.6 percent, compared with 0.6 percent among the general population. Among black transgender people, the rate jumps to 4.4 percent.

Ana B. Ibarra: 209-385-2486, @ab_ibarra