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15 Things Black Trans People Face When Going to the Doctor

Racism and transphobia won't keep these people down.

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Navigating health care appointments and insurance while trans can be challenging enough, but it can be especially difficult for trans people of color.

Fusion / Via giphy.com

According to the 2015 US Transgender Survey released late last year, one third of respondents who saw a doctor in the past year reported at least one negative experience related to being transgender. In addition to that, 40% of black trans people said they hadn't seen a doctor in the past year because they couldn't afford it while 26% said they didn't see a doctor for fear of being mistreated. These are only two of several factors that contribute to a range of health disparities among black trans people — among them, 19% of black trans women live with HIV compared to 1.4% of all trans people and 0.3% of the US population. Another one: 47% of black trans people have attempted suicide compared to 40% of all trans people and 0.6% of the US population.

For Black History Month, we're sharing the experiences of black trans people across the country in order to highlight the many obstacles they have to overcome just to stay healthy — both mentally and physically. For some extra input, we also spoke to Dr. Andrew Goodman, associate director of medicine at the Callen-Lorde Community Health Center.

Here are their stories:

1. "I know I need to go to the dentist but I’m not going to go if they’re not going to use my preferred name."

Yaz Burrell

“I’m working with this dentist. It’s not bad, but it’s not great. The dentist that I’m working with will text me to set up an appointment, and I’ve asked them repeatedly to refer to me by the name that I use and they forget it every time — they’ll still use my government legal name. Even when they see me, they’ll use my legal name but then refer to me with the correct gender. So I’ve ghosted on them a few times, and as a result of that, I know I need to go to the dentist but I’m not going to go if they’re not going to use my preferred name. It’s not a good feeling.

—Yaz Burrell, 27, Brooklyn, New York, Trans Male

2. "It went beyond what it seemed like a doctor would be interested in — I felt like an eccentricity when I was in his office."

Syd Robbie

The first doctor I went to seemed knowledgeable, but ultimately he made me uncomfortable because he was obsessed with my facial hair and body hair. It went beyond what it seemed like a doctor would be interested in — I felt like an eccentricity when I was in his office. I was going to him to find out about hormone replacement therapy, and for your everyday checkup. After I stopped talking to him, I went about a year-and-a-half without seeing other doctors because I didn’t want to go out on that limb again.”

—Syd Robbie, 34, Milwaukee, Wisconsin, Trans Man

3. "I don't have to go to therapy just so you can tell me I’m not crazy and that this is a legitimate thing."

@steroidbeyonce / Via instagram.com

“When I was going to have my top surgery, they have these requirements that you need to go through before insurance will cover your surgery. You need to have gender identity disorder diagnostics with a mental health provider. You need to be approved for hormone therapy — and a lot of people, especially non-binary people like myself don’t need hormone therapy for others to see them in the light that they see themselves. Another requirement is to have at least one year’s life experience living and working in your desired gender. What’s wrong with that is that here we have people dictating what it’s like to be trans while I've been this gender my whole life. I always knew what my identity was and I don’t need a therapist to verify that. I don’t have to go to therapy just so you can tell me I’m not crazy and that this is a legitimate thing.”

—Devin-Norelle, 28, New York City, New York, Androgynous

Goodman says these "requirements" likely came from the World Professional Association for Transgender Health (WPATH), which comes up with guidance for what needs to be done before surgery. "That being said, it does seem like an awful lot to go through, and I think the medical community needs to continue to look at these to make sure they're appropriate for safety while not throwing unnecessary barriers down in front of patients." As of this writing, WPATH's Standards of Care don't require testosterone therapy for top surgery, but Goodman says "this all comes down to what insurance companies are asking for."

4. "He was just always asking how you’d have sex, and it was almost like a pure fascination to it rather than something related to your health care."

Rae Nelson

“I’m a nurse, so I exist in a unique intersection of being a person who needs healthcare and working in health care. One of the things for me in trying to navigate my health care has been determining which direction it will go in versus being told which direction it will go in.

One of the earliest issues was my doctor asking me really sexually inappropriate questions. And I never caught on till I started talking to other trans people who had seen the same doctor. They were always sexual and inappropriate and unrelated to the health care we needed. He was just always asking how you’d have sex, and it was almost like a pure fascination to it rather than something related to your health care.

Another time, I had a UTI and had to go to the doctor for it, so i was describing my symptoms to this doctor and she was telling me that she would have to see my genitals in order to make a proper diagnosis. But as a nurse, I knew better. The tests you have to run to detect the UTI have nothing to do with seeing the genitals, so I knew it was out of her curiosity. So that’s been an issue for me — I shouldn’t have to teach doctors how to treat me, both professionally and as a human being, without wanting to dissect my body.

—Rae Nelson, 25, Little Rock, Arkansas, Trans Woman

5. "Before I found out I was autistic, mental health providers would tell me I was trans because I’m a sexual assault survivor."

"Before I found out I was autistic, mental health providers would tell me I was trans because I’m a sexual assault survivor. But now, when my autism is brought up alongside the subject of being trans, people will say, “Oh, you’re not really trans, you’re just autistic.’ And it’s just like no — I’m just trans, autistic, and a rape survivor. Those three things occur within their own space. They’re all true and they influence each other, but they do not completely overwhelm one another. One does not exist just because the other one is there."

—Zandra Gibson, 21, Detroit, Michigan, Non-Binary Femme and Trans Woman

6. "Because of the anxiety I get from how people treat minorities like me, I haven’t been able to go out and take care of myself."

Kaden Barrett

“I haven’t gone to a doctor or any other mental health professionals since I left Florida. Georgia isn’t really known to be a liberal leaning state, so I’m kind of afraid of confrontation or just dealing with people who will step out of place to try to say what I should do with my life. Because of the anxiety I get from how people treat minorities like me, I haven’t been able to go out and take care of myself. So I try to do home remedies and natural stuff that don’t involve me interacting with people. You don’t know who’s going to have a really shitty reaction to you and I would rather not deal with that.

—Kaden Barrett, 21, Savannah, Georgia, Trans Man

7. "Multiple white trans people are telling me to go to you for a service I need, so why can’t you do the same thing for me?"

TK Morton

"The main thing for me is how hard it is to access hormones in the midwest. I grew up in Southwest Michigan, and I had a lot of white trans friends with doctors who prescribed them hormones. They would tell me, ‘Oh yeah, these doctors are good, they’re OK.’

But these doctors were extremely racist toward me and they also did not feel comfortable prescribing me hormones because they thought there was going to be a lawsuit if something went wrong — they thought they were going to lose their license. Part of that I understand, but the other part of me is like, multiple white trans people are telling me to go to you for a service I need, so why can’t you do the same thing for me?

—TK Morton. 24. Madison. Wisconsin. Trans Queer Person

8. "To some people it probably seemed alarming or surprising to see this black dude sitting in a gynecologist’s office."

Tiq Milan

"Recently I had to see an OB-GYN and I had to go into her office. So I’m the only black guy sitting in the waiting room, and I could feel the eyes on me. People don’t understand that gender isn’t such a binary thing. So to some people it probably seemed alarming or surprising to see this black dude sitting in a gynecologist’s office. But this is a part of me getting my trans-related health care, it’s a part of me getting my human health care — I have to do these things. So that could be difficult. "

—Tiq Milan, 35, New York City, New York, Trans Man

9. "It just seems like we have to do a lot more legwork than people who are not of trans experience."

Alex Burns

“The biggest thing going on down here is the lack of physicians who are willing to treat trans people. There are also many who aren’t educated on how to treat or deal with trans issues. So I’d encounter situations where the doctor would use the wrong pronouns. They wouldn’t outwardly say they didn’t deal with trans people, but they weren’t really willing to respect me or try to learn about what being trans is to more adequately make me feel comfortable or give me the services I was looking for. If they did decide to do research, they would learn very outdated information.

For example, one surgeon wanted to get more information before he’d do the top surgery on me. He said he’d call me back, and it took about a month for him to do that. He said another person told him I’d need to be on testosterone for a year before he was comfortable doing any type of surgery on me. That’s considered to be very outdated information because you have some individuals who don’t want to go on hormones or can’t but they still want to have the surgery to be comfortable in their own bodies. Then there are doctors who want to help the trans community, but don’t know where to start, so you have to teach them how to treat you. So you’re doing the research and bringing it to them, telling them what you need and what they need to do to you. Then they tell you they need to go back and do their research just to make sure it lines up, and that holds you back from getting the type of medical attention you need.

It just seems like we have to do a lot more legwork than people who are not of trans experience — there’s research, calling doctors, following up on everything from beginning to end. And if you don’t check up on things, then it all kind of gets lost in the shuffle because they don’t want to go through the trouble.”

—Alex Burns, 32, New Orleans, Louisiana, Trans Male

10. "I had insurance, but once they found out I was trans, I guess they didn’t want to help me."

Jaiivon Lee Pagan

Last night I went to the hospital because I wasn’t feeling too good. I never got seen. I had insurance, but once they found out I was trans, I guess they didn’t want to help me. When I went in, the lady who was taking my blood pressure asked me all this personal stuff and made faces when I first said I was trans. I waited for three hours, then five hours in the waiting room, and they still didn’t call me into a room — they left me sitting in the waiting room the whole time while they just kept calling other people to see a doctor. I could’ve been sleeping, so I just got up and walked out thinking they probably would have sent me a crazy bill for something I could have done at home anyway."

—Jaiivon Lee Pagan, 27, Columbus, Ohio, Trans Man

11. "Either they didn’t order the vials on time or they were on backorder. That would throw my injection date off for the week."

Dezjorn Gauthier

"I pay out of pocket. My top surgery was $6,399 out of state, in Ohio. My testosterone is $100 a vial for 10ml and that’s when I use a discount card. Without it, that goes into the $200 range.

The reason I get a 10ml vial is because it was always very difficult with a 1ml vial, which is a month's supply. That 1ml vial was covered under my parents' insurance when I first started, but 10ml vials weren’t covered and they still aren’t. It was so difficult to go to Walgreens every single month — either they didn’t order the vials on time or they were on backorder. That would throw my injection date off for the week. Especially early on, when you miss an injection, it can throw your levels off. There are mood swings, other problems, and I couldn’t do it. So I told my endocrinologist and he prescribed me a 10ml vial — it’s just a lot easier paying for it all upfront."

—Dezjorn Gauthier, 25, Milwaukee, Wisconsin, Trans Male

"Someone who stops testosterone therapy may notice decreases in facial or body hair that may have grown, small increases in chest or breast size, and menstrual cycles may return," Goodman says. "Many folks will also notice changes in their mood — they probably won't feel so great."

12. "My friend would order the testosterone online and bring it to me."

Amari Vendely

"After a lot of research, I found that it was going to be really hard for me, financially, to start my transition the right way. So I made a bad decision and got some testosterone from a friend online, and I did that for the first seven months. I started hearing really bad stories about people who started doing it that way, so I reached out to my mom and asked for help. She’s supportive in that she wants me to be happy, but she said that she would never help me financially because it was such a personal decision — she was probably a little worried, too.

So my friend would order the testosterone online and bring it to me. I didn’t have the money to pay for it here in the US — it said I had to do therapy x number of times before I could even get a letter of approval to do hormone therapy. And then for the testosterone itself, you have to schedule endocrinologist appointments. It was just a lot that I could not afford, so it went on like that for a while until I could get a very amazing therapist in Miami who helped me do it all the right way."

—Amari Vendely, 33, Mt. Dora, Florida, Transgender Male

There are several reasons buying hormones online is dangerous, Goodman says. For one, there's the risk that it's mixed with other chemicals (or isn't even testosterone). A doctor also needs to teach their patients how to inject properly. But most importantly, he says, doses are personalized, so taking a dose that's too small will be ineffective, while too-large doses can cause severe mood swings (anger and rage), thicken the blood (upping risk of stroke and headaches), damage the liver, and change cholesterol levels.

13. "Because I wasn’t able to afford insurance, I couldn’t see a doctor, and I was paying out of pocket, I moved to Portland to get the services I needed."

Christian Branch

“I currently live in Portland, but when I started my transition I was living in Houston, Texas. I felt like it was one of the best places to go to get the care that I need because in Houston, it was hard. Even though I had a job, the health care plans they offered were too expensive — $400 a month — and they were not likely to cover my testosterone or surgeries. So I paid out of pocket during the first year I was on hormones. I didn’t have a primary care provider and I went to one of those clinics for underinsured or uninsured people, so there were really long waits to get seen by anyone — months versus a couple of weeks. I went in October to start hormones and my next appointment wasn't until January. So because I wasn’t able to afford insurance, I couldn’t see a doctor, and I was paying out of pocket, I moved to Portland to get the services I needed.

With the ACA, you had to look through the marketplace if you didn’t get insurance through your employer. So I looked to see if they would cover hormones (I wasn’t even looking for plans to cover top surgery at the time), and they were still $200 a month. I wasn’t making that much money where I could afford that on top of my other bills. I think that’s the biggest issue — insurance plans cost way too much just to get the bare minimum of care. Luckily I get insurance through my job now and I pay $115 a month. It’s a big difference. I’m currently home recovering from top surgery and all I paid was a $10 copay. Monthly, all my meds cost me $26. It’s a great feeling knowing that everything is covered now, down to every surgery — bottom surgery and hysterectomy even. It’s one less stress that I have now.”

—Christian Branch, 29, Portland, Oregon, Trans Man

14. "Unlike a lot of trans folk of color, I make a decent wage and it’s still hard to find inexpensive resources around transitioning."

Ray(nise) Cange

"I haven’t been getting hormone therapy because it’s too expensive. Unlike a lot of trans folk of color, I make a decent wage and it’s still hard to find inexpensive resources around transitioning. I decided to hold off until I can financially afford it, and that might mean going to Baltimore where my mom’s a hospital employee — it’s a little inconvenient because I’d have to make time to go there, but financially it’s going to be a better decision."

—Ray(nise) Cange, 24, New York City, New York, Black Afro-Latino, Afro-Indigenous Gender Non-Conforming

15. "Now the challenge that I’m having is that they’re so well known for serving the LGBT community that their therapy list fills up, and the wait can be literally months."

Renee Vallejo

“I get my primary care out of Fenway Health here in Boston. I’ve been doing it for five years now because they’re known for serving the LGBT community. I attended therapy there, I see my doctor there, and I went for top surgery there. They were very hands on with what I needed. But now the challenge that I’m having is that they’re so well known for serving the LGBT community that their therapy list fills up, the wait can be literally months.

I deal with high-functioning depression and anxiety, so when it was time for me to seek out the necessary help that I needed, I wasn’t able to see anyone. And that’s really sad because that’s the only place that I’ve ever known, or gone to, for my health care. It’s always been my go-to place, so when they said they couldn’t take me, my anxiety came full-throttle. It’s not just that there aren’t enough organizations that provide LGBT healthcare, there also aren’t enough organizations with the amount of different resources that Fenway Health has.”

—Renee Vallejo, 23, Cambridge, Massachusetts, Gender Non-Conforming

If you've had trouble finding good health care, here are some resources provided by the people above (plus some extras).

* Susan's Place is essentially a one-stop-shop for anything trans-related, with chat rooms, forums, and links to resources in the US and internationally.

* FORGE is a national transgender anti-violence organization based in Wisconsin that also provides directories to trans-friendly mental health providers and physicians.

* Louisiana Trans Advocates holds five monthly support groups across the state and connects people to trans-friendly health care providers.

* Froedert and the Medical College of Wisconsin has been recognized by the Human Rights Campaign as a leader in LGBT health care equality.

* Callen-Lorde Community Health Center provides quality health care to LGBT folks in the New York City area.

* The Mazzoni Center in Philadelphia is "the only health care provider in the Philadelphia region specifically targeting the health care needs" of the LGBT communities.

* Arkansas Transgender Equality Coalition works to advance equality among trans people throughout Arkansas by providing legal help and directories for where to find health care providers.

* Lambda Legal is a national non-profit LGBT organization that works on impact litigation, meaning it takes on cases that will impact the most people and advance their rights.

* The Fenway Institute's National LGBT Health Education Center provides people in Boston and other parts of Massachusetts with health care resources.

* Family Tree Clinic in Minnesota provides sexual and reproductive health care —as well as limited primary care — to everyone, including LGBT folks.

* The Ali Forney Center provides food, medical care, mental health services and counseling support to LGBT youth.

Some responses have been edited for length and/or clarity.

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