Transgender Healthcare 101 for Advocates

Transgender Healthcare 101

An Essential Guide for Advocates

Based on a presentation by Molly Crowther, Board Certified Patient Advocate

This guide provides essential information about transgender healthcare, focusing on advocating effectively for transgender clients in healthcare settings. As Patient Advocates, understanding the unique challenges faced by transgender individuals when accessing healthcare is crucial to providing informed support.

"The healthcare system was designed for cisgender people, but the medicine in 99% of cases that transgender people are accessing is the same healthcare procedures that were designed for cisgender people, just used for different reasons."

Understanding Key Terminology

Transgender

From Latin "trans" meaning "across." Describes a person whose experience of gender doesn't match the sex they were assigned at birth. Implies a journey from one thing to another.

Cisgender

From Latin "cis" meaning "same side." Describes a person whose experience of gender matches the sex they were assigned at birth. Creates a non-pathologizing terminology.

Sex Assigned at Birth

The designation (usually "male" or "female") given at birth, typically based on external genitalia. Preferred over terms like "born a boy/girl" or "biological sex."

Gender Dysphoria

Psychological distress resulting from incongruence between one's gender identity and sex assigned at birth, presentation, or hormonal status. Can be experienced by transgender and cisgender people.

Dead Name

A name that a transgender person was given at birth and no longer uses. Using someone's dead name can be triggering or traumatic. Historically refers to the name that non-accepting family might use at one's funeral.

Non-binary

A gender identity that doesn't fit strictly into categories of man or woman. Non-binary people may identify as having aspects of both genders, neither gender, or a gender outside the binary.

Types of Transgender Healthcare

Transgender healthcare encompasses many procedures and treatments that are also used for cisgender people, but for different purposes. These include:

Hormone Replacement Therapy

Medications to modify hormone levels in the body. May include testosterone for transmasculine individuals or estrogen and anti-androgens for transfeminine individuals.

Hair Removal

Often medically necessary for transgender individuals but frequently not covered by insurance. May be required prior to certain surgeries.

Voice Modification

Can include voice training, speech therapy, or surgical interventions to address voice-related gender dysphoria.

Chest/Top Surgery

Includes procedures like mastectomy with chest reconstruction or breast augmentation, depending on the individual's needs.

Genital/Bottom Surgery

Various surgical procedures to align genital anatomy with gender identity. These are typically the same procedures developed for cisgender individuals.

Facial Surgery

Can include facial feminization or masculinization procedures. Often considered medically necessary but frequently not covered by insurance as they're deemed "cosmetic."

Important Context:

In 99% of cases, the medical procedures that transgender people access are the same procedures developed for and commonly used by cisgender people—just for different reasons.

Transgender Healthcare for Minors

This topic is often misrepresented in media and policy discussions. Here are the facts:

Social Transition

For younger children, transition is primarily social and involves simple changes:

  • Using different name or pronouns
  • Getting a new haircut
  • Wearing different clothes
  • Playing with different toys
  • Decorating their room differently

These are changes any child should be able to make regardless of gender identity.

Medical Interventions

  • Puberty Blockers: Reversible medications that pause puberty; once stopped, puberty resumes normally. Gives families time to make decisions.
  • Hormone Therapy: Usually only for older adolescents, depending on state laws. Helps develop secondary sex characteristics aligned with gender identity.
  • Surgery: Extremely rare for minors, usually limited to top surgery for older teens after extensive evaluation and with parental consent.

Note: Many medical interventions that are considered controversial for transgender youth (like puberty blockers) are routinely given to cisgender children for conditions like precocious puberty without controversy.

State Legislation

Many states are passing or considering legislation restricting transgender healthcare for minors. These laws often:

  • Ban affirming care that is evidence-based and supported by major medical organizations
  • Force youth to discontinue existing treatments that may be working well
  • Include exceptions for the same treatments when provided to intersex youth (often without consent)
  • Affect very small numbers of youth while causing significant harm (e.g., in Louisiana, only 57 minors were receiving puberty blockers from 2017-2021)

Barriers to Transgender Healthcare

Insurance & Coverage Barriers

  • Insurance plans vary widely in what transgender healthcare they cover
  • Many medically necessary procedures are classified as "cosmetic"
  • Documentation requirements are often more stringent than for cisgender patients receiving the same care
  • Mismatch between gender markers and needed services can result in coverage denials

Gatekeeping

  • Requirements to "prove" dysphoria or perform stereotypical gender expression
  • Social transition requirements before accessing medical care (which can be dangerous without medical support)
  • Multiple letters from mental health providers
  • Requirements to "rule out" unrelated mental health conditions
  • BMI restrictions that may be more strictly applied than for cisgender patients

Provider Issues

  • Lack of provider education or experience with transgender patients
  • Provider bias or religious objections to providing care
  • Increasing legal protections for providers to deny care based on gender identity
  • Medical record systems that don't properly accommodate transgender identities

Systemic Issues

  • Long waiting lists for specialists (particularly severe in countries like the UK)
  • Geographic disparities in access to knowledgeable providers
  • Broader social discrimination affecting access to insurance, employment, and housing
  • Documentation challenges (updating name/gender on identification and records)
  • Medical trauma from previous negative healthcare experiences

Recommendations for Healthcare Advocates

Insurance Navigation

  • Review insurance plans thoroughly to understand transgender care coverage
  • Handle calls to insurance that might require using legal names
  • Research appeals processes for denials of care
  • Connect clients with specialist insurance navigators when available
  • Research alternative funding options like grants for uncovered care

Communication Practices

  • Normalize asking for and sharing pronouns in all settings
  • Ask for both legal name and preferred name, and explain why you need each
  • Help update names and pronouns with providers and in medical records
  • Use precise, accurate language when discussing transgender healthcare
  • Avoid invasive questions not directly related to the healthcare being sought

Provider Relationships

  • Research transgender-affirming providers in your community
  • Understand the power dynamics and previous medical trauma many transgender people have experienced
  • Position yourself as an ally, not another gatekeeper
  • Screen for providers who rely on informed consent rather than extensive gatekeeping
  • Prepare clients for appointments by discussing what to expect

Remember:

As a healthcare advocate, you can play a crucial role in ensuring transgender clients receive affirming, appropriate healthcare. By being informed, welcoming, and affirming, you can help create a safer healthcare experience.

Final Thoughts

"Understanding the power dynamics here—there's a lot of medical trauma for transgender people going back generations accessing medical care. You don't want to be seen as one of those gatekeepers because they're very used to that from their providers."

Transgender healthcare is fundamentally the same healthcare that cisgender people receive, just accessed for different reasons. By educating yourself about transgender healthcare needs and barriers, you can better advocate for your transgender clients in a healthcare system that wasn't designed with them in mind.

Working to ensure transgender people receive respectful, appropriate healthcare is not only important for their physical wellbeing but can be life-saving for a population that experiences significant health disparities due to discrimination and lack of access to affirming care.