What It’s Like Navigating Health Care as a Trans Woman
Add to that being a woman of color, and it's even more nuanced. Activist and artist Linda LaBeija shares her experience.
This story is part of Coveteur’s Women’s Health series. For more on this topic, head here.
With all of the legislative barriers that women face in the fight for satisfactory health care (not to mention a persistent pain gap), it should come as no surprise that, for trans women—and especially trans women of color—the struggle is even greater. With insurance carriers that refuse to cover certain medications and procedures, as well as doctors that often disregard their patients’ questions and concerns, we wanted to take a closer look at what a trans woman really goes through in the medical community. Linda LaBeija is an activist, performance artist, poet, and storyteller in many forms, and she graciously agreed to shine the proverbial light on her experience as a trans woman navigating the American health care system. Here’s what she shared.
What do you look for in a doctor?
“I have been known to seek out medical professionals of my choosing. These are basic human services that we are subjected to invest money in. Ask yourself, does this provider have any experience working with transgender or gender-nonconforming people? Are they friendly? Do they smile? Are they asking you in-depth questions about your health? I have met so many providers that are short-spoken, detached, and will run you through the hospital like sick cattle. Don’t be afraid to tell your doctor what you really need! Make sure your money is well spent, your needs are fully met, and you got what you needed from your visit.”
Are most of your needs covered by insurance?
“Most, yes, with the exception of greater ‘cosmetic’ surgeries. Surgeries that are as equally gender-affirming as those covered by insurances currently. Let’s hope it lasts. Surgeries that, in fact, cause many trans sisters that I have met a great deal of health complications. I don’t care what anyone says, facial feminization and any type of body contouring, sculpting, fat redistribution are extremely important gender-affirming surgeries. It is the reason that many older trans women I know have used silicone or other liquid-form injections as an alternative.
“Most commonly, I’ve known women to inject in the face and buttocks, whether to effeminize the face or effeminize the body. Although not all trans women have experienced the same complications, it is another major cause of health disparities amongst trans feminine communities of color. Hormone replacement therapy can already have long-term effects on your liver, your bones, your heart. Not being able to access these gender-affirming surgeries have rendered trans women of color [unable] to find other means to access what is deemed ‘cosmetic.’ Whether that be sex work, crime, etc. Or it [leaves] us to [use] the old-fashioned silicone injection, continuing the high-risk health choice, possibly gambling with our lives, depleting our livelihood. [This] only further decreasing the life expectancy rates of trans women.”
How often do you see a doctor?
“I find it most helpful to see my doctor every three months. Is that a lot? Consistency can be difficult between work, shows, and gigs, but I think about it in a seasonal kind of way. My body has changed so much physically and chemically, and I’m sure as I age more changes will commence. But between moon cycles and waves, I have found it helpful to get tested to check for hormone levels regularly. If I have had more than one partner recently, I take the opportunity to get tested for STIs and HIV, too. It’s how I make sure to actively practice self-care.”
For those interested in hormone therapy, what does that entail?
“Hormone replacement therapy, or HRT, can come in the form of a liquid injection that you or someone else can administer. Aside from daily pills, patches and topical creams are also available. Many girls I’ve met say the shots work quicker, but doctors say they work the same. I remember when I first started T blockers, the nausea was real. The hot flashes were real! Hell, I still get ’em sometimes. But they were no joke. And I wasn’t passing or cis-assumed, and between the ignorance and ridicule in the streets, there were relentless creeps trying to solicit sex, automatically sexualizing and deviating me without a single conversation. [They would be] as discreet as possible, in fear of who would see them. Sometimes I wish I could have taken my time more, not rushed so much. I’ve met some girls that chose to get on HRT first before presenting as a woman at all. Some find it more comfortable. Just another option. What I will say is that the changes it has on your body get better over time. Consistency is key. But just like surgery, clothing, or voice therapy, these are all options that could potentially make you feel better about leaving your house to access services.”
Are there any resources that you’ve found helpful?
“Apicha Community Healthcare Network. I have been going there for years. NYU Langone also ensures that I had a blessing of a surgical experience.”
Any advice to trans women having difficulty navigating the health-care space?
“After my time in foster care as a young queer adolescent, I was fortunate enough to find spaces where I could begin to explore my gender expression. Keyword: expression. I never thought that what began as discomfort with fitting into fashion norms would soon develop into exploring what I’ve come to know as my identity. In spite of the many safe spaces I was afforded to find, seeking medical care, however, has not always been so easy. Unfortunately, there are a few things I have come to expect when walking into medical facilities.
“The first is that everyone else’s ignorance will indeed render you an educator and advocate of your own basic human rights. Daily. When walking into any clinic, the first thing they always will ask is your name. Once upon a time, I got into the terrible habit of quickly presenting my insurance and ID before being asked so that I could answer as little amount of questions as possible and won’t get clocked for the bass in my voice. This can be an extremely unnerving question for some. Now, if you haven’t changed your name yet, it’s OK. It will happen when it happens. You’ll know when it’s time.
“If you haven’t started hormone replacement therapy, if you don’t feel passable, if you don’t want to get on HRT, take the liberty and courage to communicate your preferred name and gender pronouns at the start of your visit. And I’m not talking about just the doctor. More often than not, the receptionist can note this type of information in the system. Always push to be accommodated. It may feel impolite or uncomfortable, but I have found that many health-care workers either have not received training around any LGBT competence at all, or they don’t practice it, or they just simply don’t support it. Unfortunately, yes, the joy you are finding in yourself may bring out so much anger in others. And no shade, everyone else’s anger at your existence is not your concern.
“Your only concern need be your existence. Take it easy on yourself. Remember to take deep breaths throughout the day. Situations of disrespect or being misgendered can be overwhelming and anxiety-provoking. Breathe, sis. Fuck everybody else. You got this. You’ve been through worse. Just remember to eat. And love up on yourself. Hold yourself tight. Seek support when you need it. I have had so many friends come with me to see the doctor.
“My experiences in ERs have been more unorthodox. Being treated like the very word sometimes. I remember once experiencing a sprain and seeking emergency medical attention after getting off a very long overnight shift. Working with runaway homeless youth wasn’t always easy. And back then, forms were not as inclusive to ask gender preference or gender pronouns. It’s funny, a coworker reminded me recently how intelligent language around sex and gender is now. So if you ever see otherwise, don’t be afraid to suggest they update their forms, and that the forms *do* exist.
“Anyway, I’m waiting to be seen by lord knows who. One nurse came, took my vitals, left. Then another to update the computer about what I was experiencing. Then I was asked when my last period was…and I didn’t know what to say. On one hand, I felt oddly happy to have been cis-assumed, but for the first time, I felt the weight of a secret I felt I had no choice but to hide. I uncomfortably revealed that I do not get a period.”
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