The State of Transgender Healthcare

by Pat Magee, MSW

Rage Monthly

Saturday August 23, 2014

I've yet to meet a gay or lesbian person who needed to be treated medically for their sexual orientation. But many, if not most, transgender people require medical treatment to find some sense of relief and comfort with their bodies.

Transgender people often use hormones and/ or surgery to align their anatomy and secondary sexual characteristics (breasts, facial and body hair, muscle mass, voice, etc.) to match their sense of self. Medical differences that may help to create some of the confusion and disconnect with the gay community as a whole.

Although homosexual and transgender people are both "sexual" minorities in our society, transgender struggles are often quite different in terms of having our needs met and in moving beyond general equality and acceptance. There has been a long history of lack of access to basic healthcare and systematic discrimination for transgender people. Even today, most medical schools devote minimal time and training to transgender health needs and professional healthcare providers often refuse to treat transgender patients based only out of the fear of the unknown.

In reality, most transgender-related health needs are conventional and can be managed by any capable doctor, requiring minimal specialized training and generally basic understanding and compassion.

Another factor that has been problematic is the hesitation of transgender people themselves to access care. Born out of the fear of humiliation, disrespect and rejection, some transgender people may not even make an attempt to seek required care. Sadly, important health needs such as PAP smears, prostate exams and mammograms are often avoided just because a transgender person does not believe they will be treated appropriately and with dignity.

I have personally been laughed at directly, by medical staff, while in a paper gown awaiting a pelvic exam. Others have shared with me having been refused life-saving care, being openly called "it" by nurses, or the humiliation of having a parade of curious hospital employees lifting the gowns of a semi-conscious transgender patient to peek at their body and genitals. These stories are horrific and justify the concern and demand for more sensitivity training and the need for stronger advocacy.

Fortunately, and just within the last few years, tremendous strides have been made. In the recent past, 100 percent of transgender-specific health needs had to be paid out of pocket. Now, many insurance companies are taking on the responsibilities of helping to manage costs.

Previously, transgender care was considered experimental or cosmetic. Even complications from said care were excluded. Thankfully, in 2008, the American Medical Association and the American Psychological Association recognized that transgender transitional care is a legitimate health issue and considered medically necessary. Medi-Cal (health insurance for low-income residents in California) has covered transgender-related treatment for a long time; however, actually finding a provider that will accept the low payment offered was most often impossible.

Medicare, the federal health insurance for the permanently disabled and those over 65, has also recently begun to cover treatment and surgery. Kaiser Permanente has even established a group that meets weekly in Santa Ana for its transgender members to network and find support. It has taken a great deal of persistence, but positive changes are taking place in terms of seeking and locating transitional support and care.

There has been a long history of lack of access to basic healthcare and systematic discrimination for transgender people.

Newer challenges include locating services and providers for transgender children who are transitioning at very young ages. They have a whole new set of issues with which to contend and whose families require a great deal of support and guidance. Additionally, a variety of healthcare facilities and caregivers need more specialized training for the care and handling of transgender patients and residents.

A lack of healthcare services in general for the transgender community remains the greatest challenge. More compassionate healthcare providers are needed to come forward and become involved. To connect, please contact your local LGBT community center. For questions and information regarding referrals, sensitivity training and advocacy, please contact [email protected]. com.



Contact the Los Angeles LGBT Center at


Contact The Center Orange County at


Contact The Center Long Beach at


Contact the North County LGBTQ Resource Center at or The San Diego LGBT Community Center at

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