The State of Transgender Healthcare

Submitted by Anna Loy on Wed, 05/20/2020 - 13:55 - 0 Comments
Every time I look in the mirror, I see a reflection of who I am, inside and out. The body I was born with matches my identity. I have not had to pay, take hormones, or undergo surgery to be myself. That is not true for everyone. 
According to a New York Times study, there are roughly 1.4 million adults identifying as transgender across the United States. An additional 150 thousand teenagers across the country identify as transgender, over two percent of the country’s teenage population. Access to transgender health care, though limited, is growing nationwide. However, many hormonal and surgical options have side effects, forcing transgender patients to weigh health needs against their true identity. 
I talked to an anonymous, transgender teen who has been on hormones since last September about his experiences with transgender health. He says the process has been “smooth” and that “the whole dysphoria aspect is so much easier” after starting hormones. He did note, though, that there are many side effects. 
“I get grumpy every time my dose gets upped, which has only happened a couple of times.”  
The hormones can also change a patient’s mood throughout the week. My source says,  “Because I am giving myself a prescribed dose over a very concentrated hormone every weekend, there are definitely mood swings. I get my shots on Sunday so Friday night through Saturday I get pretty emotional.” 
Despite the side effects, he thinks that using hormones was a good choice, saying, “For three or four years I felt like I was stuck as a twelve-year-old. And for the last year or so I feel like I’ve been more myself.” For other transgender teens considering hormone use, my source says he would “definitely recommend it.” 
I also talked to Dr. Jens Berli, a plastic surgeon specializing in transgender health at OHSU. He says that hormone treatment, not surgical treatment, is often the recommended plan for transgender teenagers. Dr. Berli notes that hormone treatment is reversible, which is a much better option for patients uncertain about the outcome. 
Also, many surgical options are more invasive with more extensive side effects. According to Dr. Berli, facial feminization and masculinization surgeries take about a year of hormone use leading up to the surgery, and another year after the surgery for the swelling to go down.  
Other surgeries, like chest feminization or chest masculinization surgeries, can be less invasive. Dr. Berli says that these are better for teenagers. He thinks that these gender-affirming surgeries are important because “They help students not get hazed in school and participate in sports.” 
My source plans on getting a chest masculinization surgery this June. He is getting a periareolar top surgery, which is a less invasive type of chest masculinization surgery often recommended for teenagers. On why he wants to undergo surgery, my source says, “I really hate binding. It is awful, it’s hot, it’s sweaty and it’s uncomfortable. It’s just not a good experience all around. And honestly, I would just like to be done with all that.” 
The application process to undergo surgery is very thorough. On this, my source said, “Since I am under eighteen I had to go to this second, psychiatric review to start.” After his mental health review, he talked to his doctor and got a referral for surgery. He thinks, “It’s been pretty smooth, but there is a lot of bureaucratic hold-up, and it has taken a lot of time.” 
He has Kaiser health care, which he likes. He says, “They have a whole transgender clinic, which is great.” Kaiser’s transgender healthcare is very advanced because they do most of their surgeries through the OHSU program Dr. Berli is part of. He describes the care at OHSU as “multidisciplinary care, including, psychosocial evaluations and general primary care. Fertility counseling is an important part of our program as well.” 
For minors, Dr. Berli says that mental health is an important aspect of care, so psychiatry plays a large role in their health plans. He believes that mental health consultations are important for minors because “They often help the patient and their families.” He notes that after surgery it is important for patients to continue seeking counseling. He says, “Expectations can be high and reality can be disappointing” making the post-operation transition especially difficult for certain patients. 
Not only are there emotional and physical side effects for many transgender patients, but the cost of medical care can also be very expensive. Gender affirming surgeries can cost up to $80,000, and hormone treatments can cost up to $30,000, yet 14% of transgender Americans don’t receive insurance coverage for these operations. Counseling can also add cost for transgender patients. 
Cost isn’t the only barrier making transgender healthcare inaccessible. Proximity can also get in the way since transgender health programs are spread across the country. Though more hospitals offer care each year, many patients have a hard time finding doctors near them who can perform the surgeries they need. Dr. Berli weighed in on this, saying, “Gender surgery was also not part of plastic surgery programs at medical school, meaning the craft has not been maintained at academic centers.” 
This means that there aren’t many doctors trained to operate on transgender patients. OHSU is the only hospital on the West Coast north of San Francisco that performs gender-affirming surgeries, including hospitals in Canada and Alaska. 
With the Covid-19 outbreak, many gender-affirming surgeries have been postponed. The American Colleges recommended postponing any elective surgeries back in March, and gender-affirming surgeries fall into this category. The National Center for Transgender Equality (NCTE) is concerned about this, seeing that gender-affirming surgeries are vital to many individuals. They urge those who are struggling with postponed surgeries to seek help during this time. Gender affirming surgeries can take many years to prepare for, so postponed surgeries are a huge setback. 
Though the future is uncertain, we can hope that as the virus spread slows down, transgender care can be back in full swing soon. 

About the Author

Anna Loy's picture

I am a sophomore and this is my first year on Beyond the Flock staff. I am really exciting to be writing this year.