The sickening truth about trans* health

I spend way too much time on Facebook. In my case, the line between “guilty pleasure” and “mind-numbing addiction” is embarrassingly fuzzy.  We’re talking DSM-style addiction here. (Okay, so the word “addiction” doesn’t appear anywhere in the DSM – so, to be diagnostically accurate, let’s call it “dependence” instead.) Over time, my Facebook usage has gradually increased. When I’ve gone for a while without checking my Facebook page, I get the mental shakes. If it’s nighttime, and I tell myself, “Oh, I’ll just check Facebook really quick,” that’s a guaranteed hour down the drain. And hey, I could quit anytime I want to. Right?

Facebook Anonymous, here I come.

Now, in defense of my excessive Facebook usage, let me say this: every once in a while, something important gets posted on Facebook that doesn’t show up anywhere else.  Like this:


Help Kate Bornstein stay alive? I think to myself. Whoa.

Kate Bornstein was the first person to really get me thinking about gender. Years ago, when a friend of mine was undergoing a gender transition, I read Gender Outlaw. Then I read My Gender Workbook. Both of those books took my previous understanding of gender and blew them to bits. As a humble admission, her work also gets credit for saving my relationship with my gender-transitioning friend (a relationship that was cracking at the seams due to my ignorance, transphobia, and unwillingness to explore discomfort). After reading her books, the seed-concept of “men, women, and the rest of us” was planted, and, like any hardy perennial, it has grown, flourished, and matured.

But even the hardiest of perennials don’t last forever. Kate Bornstein has two forms of cancer. For the last 15 years, she’s lived with chronic lymphocytic leukemia, a very slow-progressing cancer that often doesn’t require immediate treatment. This past year, she was diagnosed with lung cancer – and that has been a game-changer. She underwent surgery last August, but the cancer is back – and her treatment needs to go into high gear. “High-gear” means chemotherapy, radiation, tons of supplements – and a high insurance deductible, high co-pays, and a hiatus from work (which, in her case, is self-employment – writing, performances, and speaking engagements). Lots of money going out, no money coming in.

When I saw this announcement on Facebook, my thought process went in two different directions. One was just sheer disbelief – a normal reaction when you’re confronted with the mortality of an icon. But the other thought-direction was this: Being trans can’t make this easy.

In some ways, Kate Bornstein is one of the lucky ones. She has health insurance (albeit a high-deductible policy). She’s well-known in the LGBTQ community, and she has a lot of fans, supporters, and followers. In three days, her GoFundMe campaign has raised over $82,000 (with a goal of $100,000). Most people in the trans* community are not so fortunate.

Here’s the reality. According to a study conducted by the San Francisco Department of Public Health, 41% of transmen and 52% of transwomen lacked health insurance. Half had experienced employment discrimination because of their trans* status (and, for many people, unemployment and underemployment means no health insurance). For most of the participants in this study, purchasing an individual health insurance policy was out of the question – the reported median income was $744 for transwomen and $1100 for transmen. And according to several studies, trans* youth and young adults are significantly more likely than their lesbian, gay, and bisexual counterparts to experience family violence, parental rejection, eviction, and loss of financial support. When confronted with a life-threatening illness, it’s common to turn to family members for emotional and financial support – but, for many transpeople, that just might not be an option. (The film Gen Silent shows this very powerfully through the story of KrysAnne, who also, ironically, was battling lung cancer.)

However, there’s another health care-related issue that marginalizes transpeople even more powerfully than the lack of health insurance. It’s called the “transgender exclusion,” which can take several forms. First, transpeople can be denied health insurance solely on the basis of gender identity – despite the fact that the American Medical Association issued a policy statement opposing this practice. Second, insurance companies can deny coverage for claims related to gender transition. This is probably the most common form of the “transgender exclusion,” and it’s the trans* health care issue that’s probably gotten the most air time in the media. (Ironically, while hormones are often not covered for transpeople, in the general population they’re among the most commonly prescribed drugs. When I was preparing to go through donor insemination, the doctors were handing out hormones like candy – and I was considered to be a “noncompliant patient” for refusing to taken them.)

But there are more subtle, insidious, and dangerous forms of the “transgender exclusion” to those of us who have never walked in a transperson’s shoes. For one thing, insurance companies routinely deny coverage for gender-specific health issues. If a transman is registered with his insurance company as male, and he needs a Pap smear, chances are he isn’t going to get it. If a transwoman has prostate cancer, it’s highly likely that her insurance company won’t cover her treatment.

The worst-case scenario? In some cases, an insurance company may fail to cover any treatments, arguing that their medical concern is the direct or indirect result of hormone therapy, surgery, or other transgender-related treatment.  Jamison Green, author of Becoming a Visible Man and president-elect of WPATH (World Professional Association for Transgender Health), told me this story when I interviewed him for my upcoming book:

[I know a woman who] was riding a bicycle, skidded and fell, and broke her arm. She was taken to the emergency room and treated, but a few months later she got this humongous bill. She called and said, “What’s this about?”

They said, “You’re transsexual, and our policy prohibits treating transsexuals.”

She said, “My broken arm has nothing to do with being transsexual.”

They said, “You’ve taken those hormones, and they affect every part of your body. As far as we’re concerned, any part of your body that has been affected by your sex change is ineligible for treatment.” 

Ineligible for treatment. That’s about as dehumanizing as it gets.

Please consider supporting Kate Bornstein in her fight against cancer. More importantly, please take the time to learn more about transgender health care discrimination. If you’re in Northern California, the Center of Excellence for Transgender Health, in conjunction with WPATH, is hosting the 2013 Transgender Health Summit on May 17th and 18th. Check it out.

1 Comment

Filed under gender nonconformity, health, human rights, San Francisco, transgender, transphobia

One response to “The sickening truth about trans* health

  1. Pingback: Privilege | Transilhouette

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