Topic: Discrimination in Healthcare

[NYC Nurse]

Hi Everyone,
Can you tell me about your experiences with healthcare?
Have you ever felt discrimination from the healthcare system?
What do you think are the most import changes that could be made in healthcare to be more welcoming and inclusive?

~NYC Nurse

[Rakel]

I have worked in the health care industry for many years and things are way different now than they were years ago.

In the 1970's every health care worker I knew made fun of transgender people. Well, so did the news industry and just about everyone else. The situation did not change until the internet showed many people just how many there are like us and we are not joking, we are serious about our gender issues.

Today, healthcare workers have been leaders in non discrimination, non judgement for everyone, not just those with gender issues.

[Megan.]

I've met plenty of uneducation in my interactions with the NHS services in the UK, but - in my own experience - it has always been courteous and professional.

The legal protections in the UK are strong, so a trans person would always expect a good quality of care, and make a formal complaint if they don't receive this.

Sent from my MI 9 using Tapatalk

[Nadine Spirit]

I've had good and bad experiences with healthcare. 

Some bad:
- my employer does not cover anything trans related, no dr's, therapy, meds, procedures, surgeries, even for things they will cover for cis-people (it's called a self pay insurance plan, it is covered under ERISA of 1974)
- when I first told my PCP at a physical, she insisted on relentlessly questioning my sexual habits even though I had just told her I have been with my wife exclusively for 25 years, she told me it was for my wife's protection
- there are no gender specialist therapists any where within driving distance of where I live in Central California
- there are maybe 1 or 2 doctors willing to prescribe HRT within about 2 hours drive surrounding my house

Some good:
- I can drive to LA where I have an amazing HRT dr
- I have an amazing therapist who used to live locally, but now I can work with online
- I have fairly close local-ish access to amazing surgeons in SF and LA

[NYC Nurse]

Thank you Rakel, Megan and Nadine for your response, I appreciate you sharing your experiences!
I'm happy to hear this, I was expecting to hear multiple horror stories.  The class that I'm currently taking, totally online, I openly discuss issues that impact LGBTQ+ community.  It is rare to get any response from fellow students, and I feel a sense of exclusion from the group.  Recently, I discussed the inequities in healthcare outcomes that impact our community, again no responses, but several nurses started posting scripture (not directly as a response to me, but when commenting on their definition of family), reciting passages about man/woman, Adam/Eve, procreation....I told them  they were offensive to me, the LGBTQ+ community and any other student present who didn't share their beliefs.  There wasn't any apology, no response as expected so I feel I have much work to do educating this group of nurses. 
Yes, Nadine, I would agree with you, those are certainly negative experiences.  Why do you think there is such an issue obtaining HRT? I have heard this before from the trans community.
~ NYC Nurse

[Nadine Spirit]

I think there are problems with obtaining HRT due mainly to ignorance and fear.  I have read accounts of doctors who know nothing of delivering hormone therapy, and who prefer it that way as they personally are not in support of transgender people, so a willful ignorance.  Though there are small town doctors who are willing to try and learn about HRT that is tough to do well.  Typically the only specialists are endocrinologists, but even then many of them only know of hormone therapy for cis people and not trans. 

A sad reality is that when you are estimated to be 0.6% of the population our needs are not deemed a high priority. 

[Lady Sarah]

Pay attention to what is happening in Texas right now, after Governor Abbot told social and healthcare workers to turn away LGBTs and the disabled.

[Confused1]

Recently, I discussed the inequities in healthcare outcomes that impact our community, again no responses, but several nurses started posting scripture (not directly as a response to me, but when commenting on their definition of family), reciting passages about man/woman, Adam/Eve, procreation....I told them  they were offensive to me, the LGBTQ+ community and any other student present who didn't share their beliefs.  There wasn't any apology, no response as expected so I feel I have much work to do educating this group of nurses. 

~ NYC Nurse

Hi NYC Nurse,

I am a Christian who lives in a very conservative area. I don't know if you are or not, but if you want to educate this group, I can give you a couple of videos that might help. One is in the Christian forum under Intersex and the Church. It is long, about 50 minutes worth, but actually goes into what the bible really says about us, YES US! I have another one that is a little over 16 minutes long that might shock some of them into reality. I have had luck with both of these if you can get them to watch. Here is the link for the shorter one:



Both are about Intersex, but apply to us as well.

Hugs,
Mike

[KateR]

Hi

I haven't experienced any discrimination in a professional setting - per se.  A Dr. and his wife I know from church disengaged with my wife & I after I was outed to him during a hospitalization.  Unless a person wants to live dangerously, the EMR doesn't lie.

What I have run into is a need to educate, or the provider simply referring me elsewhere.

So I've consolidated my health care in Kansas City which is a 3 hour drive for me with a health system that has a complete transgender medicine program.  I've been totally thrilled with how I'm treated and the care I receive.

Not the most convenient, but as long as I can avoid an emergency, it's higher quality Healthcare.


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[JudiBlueEyes]

When I asked my PCP for a recommendation for an endocrinologist for HRT, he was very kind.  He's older like me and originally from South America.  He's good and never misgenders me.  When I first came out and was still dressing male I saw a specialist who I could tell was surprised when she walked in the room. (I was never very masculine looking.)  Later I spoke to her about her reaction to explain my status.  She was very happy for me and asked a number of good, polite questions.  I've had nothing but good reactions and responses from medical personnel.  I do live in the Northeast part of the country so this may have something to do with it. 

[sarahc]

I think that the biggest problem in trans healthcare is that too many transgender people are forced to use practitioners who aren't trans specialists. The reality is that most non-trans specialists don't know what they're doing and create complications. Example: too many trans people are referred out to an endocrinologist for HRT - that is annoying and a waste. A trans-focused PCP (like mine) knows hormones enough to understand proper treatment and potential warning signs without needing to refer out to a separate specialist. In general, trans people would be much happier if they really stuck with specialists and had access to trans specialists.

I am very fortunate to live in a state with pro-trans insurance laws and a metropolitan area with plenty of trans care specialists - this has enabled me to have access to excellent care. Especially in large and medium-sized metropolitan areas, I think most trans people would benefit dealing solely with trans specialists as part of an integrated care setting (both medical and psychological). In fact, there are now many large research hospitals who have set up such networks (eg, Mount Sinai in New York, UCSF and Kaiser in the Bay Area, etc.), and these complement the previously existing transgender-centric services provided by LGBT-focused medical centers, like Callen-Lorde in NYC and Whitman Walker in DC (and other similar centers found in large cities).

The next step is to encourage the creation of such integrated transgender practices in medium-sized metros, especially those that can also serve as a hub for unserved rural areas in the vicinity of the metro area.

Tougher situation in very rural areas, because there aren't going to be enough people to support a full-time trans practice - the better first step there is to encourage more generalist LGBTQ medical practices in regional rural health hubs, especially with the LGB part of the rainbow having fairly broad acceptance in society at this point. Every rural state should have at least one well-marketed LGBT practice, which is on the cutting edge of offering virtual services.

Finally: it is commercially challenging to sustain trans-knowledgeable practices unless insurance reimburses for trans care. We still need continue to the political fight to get many conservative states to mandate trans care as part of their state insurance laws and regulations. Federal laws and regulations help, but the real unlocking power is getting more state insurance agencies to mandate coverage.

Sarah

[NYC Nurse]

Great feedback from everyone, Thank you all so much!
     That's great Confused1/Mike, the video is positive energy and I very much would like the link to the longer video too!  What makes me happy about this group/for all of you is your resiliency.  I think we're all blessed, being able to live our authentic lives when so many others do not. 
     Do any of you know members of the trans community who haven't been so lucky?  What initially drew me specifically into the trans community was when I read a multitude of research studies that show statistically significant healthcare disparities where individuals do not have appropriate healthcare/insurance, have encountered employment and housing discrimination, high rates of incarceration, attempted suicides, depression, HIV,  alcohol and drugs and often forced to work in the sex industry.   It just breaks my heart. 

What do you think would have the most significant impact to turn these lives around?     
       
NYC Nurse     

[sarahc]

Great feedback from everyone, Thank you all so much!
     That's great Confused1/Mike, the video is positive energy and I very much would like the link to the longer video too!  What makes me happy about this group/for all of you is your resiliency.  I think we're all blessed, being able to live our authentic lives when so many others do not. 
     Do any of you know members of the trans community who haven't been so lucky?  What initially drew me specifically into the trans community was when I read a multitude of research studies that show statistically significant healthcare disparities where individuals do not have appropriate healthcare/insurance, have encountered employment and housing discrimination, high rates of incarceration, attempted suicides, depression, HIV,  alcohol and drugs and often forced to work in the sex industry.   It just breaks my heart. 

What do you think would have the most significant impact to turn these lives around?     
       
NYC Nurse   

When you start talking about trans people who also have serious mental health issues and are poor, I think it’s more a broader societal problem, not a problem specific to the transgender community. Poor people, even with Medicaid, don’t have good, free access to mental health care. Improving care for trans people who face multiple challenges first requires addressing broader issues around access to quality mental health resources.

Sarah

[NYC Nurse]

Pay attention to what is happening in Texas right now, after Governor Abbot told social and healthcare workers to turn away LGBTs and the disabled.

Hi Lady Sarah!
It's disgraceful, on so many levels.  I stand with you, for you and advocate for you! I think the next 4 years are going to be much better for the LGBTQ+, the Universe and especially the Trans community!  Your post is exactly why I am here, in my opinion, healthcare is a human right, not something that depends on who happens to be in office.  When our elected officials attempt to deny rights, especially healthcare based on personal or religious views to any member of the LGBTQ+ community, especially the trans community we need to stand together and unite.  Recent attempts to discriminate against the trans community by refusing admission to homeless shelters and to allow any healthcare provider the right to deny care to a trans person based on religion is unconscionable.  I get so upset when I see members of our community supporting individuals creating these policies.  I want all of us to have equality, and most importantly healthcare that is free from unconscious bias and discrimination.  Hang in there, and never loose your positivity. Things are going to be OK.
~NYC Nurse           

[Lady Sarah]

Hi Lady Sarah!
It's disgraceful, on so many levels.  I stand with you, for you and advocate for you! I think the next 4 years are going to be much better for the LGBTQ+, the Universe and especially the Trans community!  Your post is exactly why I am here, in my opinion, healthcare is a human right, not something that depends on who happens to be in office.  When our elected officials attempt to deny rights, especially healthcare based on personal or religious views to any member of the LGBTQ+ community, especially the trans community we need to stand together and unite.  Recent attempts to discriminate against the trans community by refusing admission to homeless shelters and to allow any healthcare provider the right to deny care to a trans person based on religion is unconscionable.  I get so upset when I see members of our community supporting individuals creating these policies.  I want all of us to have equality, and most importantly healthcare that is free from unconscious bias and discrimination.  Hang in there, and never loose your positivity. Things are going to be OK.
~NYC Nurse         

If you had paid attention, you would have noticed instant backlash that got that "law" reversed when many of the places that were expected to discriminate shut down, and the workers went on strike. If the LGBTQ++ community could not be served, nobody was going to be served. In the nation's biggest red state, that was a bold move, but not by just one office, but by dozens. That bold move told the state legislators that such a law was not going to be acceptable, even in Texas.

[NYC Nurse]

When you start talking about trans people who also have serious mental health issues and are poor, I think it’s more a broader societal problem, not a problem specific to the transgender community. Poor people, even with Medicaid, don’t have good, free access to mental health care. Improving care for trans people who face multiple challenges first requires addressing broader issues around access to quality mental health resources.

Sarah

Hi Sarah,
Thank you for responding, I completely agree with you.  I think many of the challenges our community faces are in direct response to the way society has treated our community.  If society treated the community equally, I'm certain many of the mental health challenges that our community faces on a daily basis would reduce significantly.  The facility I work at here in NYC is VERY proactive on educating all staff on inclusivity and cultural competence.  Computer systems have all been changed to accommodate our community.  No longer, do you have to worry about being called out my in packed waiting rooms by your legal name, and when same sex parents have a child, the forms forms no longer say, "Mother/Father", many bathroom signage is now gender neutral.  It's a small step, but I think it really does matter.  Now we all have to work together to get census 2030 to count our community so appropriate resources are allocated.
~ NYC Nurse     

[NYC Nurse]

If you had paid attention, you would have noticed instant backlash that got that "law" reversed when many of the places that were expected to discriminate shut down, and the workers went on strike. If the LGBTQ++ community could not be served, nobody was going to be served. In the nation's biggest red state, that was a bold move, but not by just one office, but by dozens. That bold move told the state legislators that such a law was not going to be acceptable, even in Texas.

Hi Lady Sarah,
Living here in NYC, I wasn't aware of that, but I think that's fantastic! Thank you for that information.
~NYC Nurse

[Lady Sarah]

Hi Sarah,
Thank you for responding, I completely agree with you.  I think many of the challenges our community faces are in direct response to the way society has treated our community.  If society treated the community equally, I'm certain many of the mental health challenges that our community faces on a daily basis would reduce significantly.  The facility I work at here in NYC is VERY proactive on educating all staff on inclusivity and cultural competence.  Computer systems have all been changed to accommodate our community.  No longer, do you have to worry about being called out my in packed waiting rooms by your legal name, and when same sex parents have a child, the forms forms no longer say, "Mother/Father", many bathroom signage is now gender neutral.  It's a small step, but I think it really does matter.  Now we all have to work together to get census 2030 to count our community so appropriate resources are allocated.
~ NYC Nurse     

I am an elder within the trans community. I had all my documents legally changed decades ago. I never had children, so no worries about how they might address me.

I only lack one surgery. That one surgery requires going through more gatekeepers (shrinks) because the first surgical letter I got is too old. I ended up having to move to get away from an abusive ex that was tracking me and stalking me, so I moved across the country where he would least likely be able to find me. So far, it's been 26 years, and he hasn't found me. But... I cannot find a shrink I can trust enough to believe I will ever get a letter.

[NYC Nurse]

I am an elder within the trans community. I had all my documents legally changed decades ago. I never had children, so no worries about how they might address me.

I only lack one surgery. That one surgery requires going through more gatekeepers (shrinks) because the first surgical letter I got is too old. I ended up having to move to get away from an abusive ex that was tracking me and stalking me, so I moved across the country where he would least likely be able to find me. So far, it's been 26 years, and he hasn't found me. But... I cannot find a shrink I can trust enough to believe I will ever get a letter.

Happy Thanksgiving Lady Sarah and to everyone!
     Thank you for sharing your very personal story of an abusive ex.  Sadly, you're not alone, and I can only imagine the circumstances where you felt you had to relocate to escape from this horrible person.  Vawnet, a project of National Resource Center on Domestic Violence, discuss violence towards trans and non-binary individuals stating "more than half (54%) experienced some form of intimate partner violence, including acts involving coercive control and physical harm".   
     Trust is an essential part of any relationship, and even more so with our chosen medical team.  I admit, I'm totally ignorant on what is involved for the surgical letter and when I googled it I saw that it varies by state and insurance carrier, some requiring multiple letters from an assortment of providers? Could you tell me more about that? I also presume this isn't a one time office visit.
    On the bottom of your profile you list your surgeries with dates, your journey has been a long one, your determination and perseverance is very clear to me.  I'm happy to see you found caring, support and most importantly love from someone you trust.  Don't give up on finding the right therapist and getting your final surgery, with Covid I wonder if you can achieve this with virtual visits?
NYC Nurse

[ChrissyRyan]

Happy Thanksgiving Lady Sarah and to everyone!
     Thank you for sharing your very personal story of an abusive ex.  Sadly, you're not alone, and I can only imagine the circumstances where you felt you had to relocate to escape from this horrible person.  Vawnet, a project of National Resource Center on Domestic Violence, discuss violence towards trans and non-binary individuals stating "more than half (54%) experienced some form of intimate partner violence, including acts involving coercive control and physical harm".   
     Trust is an essential part of any relationship, and even more so with our chosen medical team.  I admit, I'm totally ignorant on what is involved for the surgical letter and when I googled it I saw that it varies by state and insurance carrier, some requiring multiple letters from an assortment of providers? Could you tell me more about that? I also presume this isn't a one time office visit.
    On the bottom of your profile you list your surgeries with dates, your journey has been a long one, your determination and perseverance is very clear to me.  I'm happy to see you found caring, support and most importantly love from someone you trust.  Don't give up on finding the right therapist and getting your final surgery, with Covid I wonder if you can achieve this with virtual visits?
NYC Nurse

Have you tried to receive a qualified therapist for surgery recommendations referral from a Transgender center?  I would state your goal, and if two or more different such letters are required, to obtain two trusted referrals.  Not sure if these letters need to be from PhD level or Masters level therapists.

I wish you well. I am sorry you had abusive treatment. 

Hugs,

Chrissy