A Nice Afternoon With The Women Of New Orleans' Trans Veterans Support Group

    Though transgender people are still barred from openly serving in the military, a small but increasingly visible population of veterans are demanding health care from the Department of Veterans Affairs — and getting it.

    Be it noted: This is an unusual story. It contains an unusually high number of positive moments and anecdotes, especially considering the general coverage of its topics. They include:

    1. Transgender women.

    2. Veterans.

    3. Medical treatment from the Department of Veterans Affairs.

    You can imagine the potential for disaster in a story that combines 4. All of the above.

    And there is some of that — disaster — in the accounts of the attendees of the New Orleans VA Transgender Support Group, which meets at the VA mental health clinic on Canal Street Friday mornings. Some of these veterans have been treated less than perfectly in their history of health care (and the VA itself has certainly been beleaguered and at times disastrous in recent years). And after all, transgender people are not allowed to serve in the military, of which these veterans were obviously all a part, some with more devastating results than others. But mostly, where the elements of transgender, veterans, and VA treatment intersect in this group, there is — surprisingly, counterintuitively, upliftingly — not that.

    Our guide to the group will be one Ms. Donna Jean Loy. She is the one who corrals everyone to Mandina’s Restaurant, an old-school Creole joint in a big pink house on Canal down the street from the clinic, after a meeting on a recent Friday.

    Donna Jean is a 65-year-old who served in the Air Force in Vietnam from 1969 to 1970, on a flight crew for C-130s and C-141s. At Mandina's, she sits in the middle of a long table, a bunch of wooden tables pushed together, as the other ladies start to trickle in across the wood floor. The table is at the back of the back room, which is roomy, but not enough to entirely diffuse the smell of foods frying.

    Donna Jean is a buoyant strawberry blonde. (It’s a dye job, to cover gray.) Her hair is long but actually shorter than how she wore it in her early veteran days, when she presented as a man with long locks, so long, down to her ass, but hippies did that too in her time so it was still stealth. During her tours of duty, Donna Jean kept ladies' undergarments on beneath her men's uniform, and when her fellow soldiers expressed hope that they wouldn’t be shot down, she agreed heartily, though for the different reason that she didn’t want capturing enemy forces ripping open her flight suit and discovering her identity.

    She didn’t — get shot down. Or discovered. Today she says her transition work is complete. Her Louisiana driver’s license and federal Social Security card are gender-correct, as is her VA ID card, and she can explain the processes to others for how to get those things done. She started coming to the group at the request of her treating VA doctor — who is also a trans woman, but we’ll get to her in a bit — more to offer support than to receive it. She feels a bit like a mother to some of the younger, or less further along, gals.

    A woman named Dee Fulcher sits down next to Donna Jean, dropping her keys on the table. Dee was in the Marine Corps for 13 years — Desert Storm, Beirut, Grenada, Honduras — the baby of the group not quite in age (52) but in transition (she started just last year, and still shows up presenting as male to coach her kid’s soccer team and to work, on an offshore oil platform).

    After everyone else arrives and is settled, there are a total of eight women here to eat onion rings or pasta or po’boys. There are a couple of trans men in the group, but they almost never come. “The trans men are so stealth,” Donna Jean says. “They start taking testosterone and after they transition they just slip right into society.” They have different kinds of — and, in the opinion of many in this group, fewer — problems, even though these also happen to be the only people of color in the group. (Overall, trans people of color are statistically more likely to experience transgender-related job loss, denial to homes or apartments, harassment or assault by police, and physical and sexual assault at work.)

    So there’s Donna Jean, or DJ, as her friends often call her, and then Dee to her left, and to Dee’s left, at one head of the table, is Stephanie Lee Grathouse, 59, also Marine Corps, who served in Vietnam and Guam and Sydney and who says she had her share of rendezvous with other soldiers when nights got lonely and dark or drunk. To Stephanie’s left, on the other side of the table from Donna Jean, is Deanne Cooley, 55, one and a half years in the Marine Corps Reserve and four years in the Air Force, noncombat, whose ex-wife talked her into therapy in hopes that she’d get “fixed” but which ultimately led to her decision to transition; she’s been Stephanie’s partner since 2008. Next to Deanne is Bobbi Perry, a biker gal in a Harley shirt, leather vest, and skirt who was in the Air Force briefly in the ’70s, also noncombat, formerly homeless, and sassy with the busboy (“I’m eatin’, baby”). The next veteran to her left is Caroline L’huillier, 51, blonde-haired with blue eyes and matching nail polish, Navy brat cum Louisiana National Guard/Iraq veteran, clearly close friends with Bobbi W., 72, the Vietnam vet next to her, at the other head of the table. Both of them served, in different decades and wars, in or attached to the 173rd Airborne. They join hands on top of the table in a mother-daughter way from time to time. Finally there’s Pamela Raintree, 62, finishing the tour around the table right back at Donna Jean’s right. She is famous here and on Google for getting a Bible-quoting council member in Shreveport, Louisiana, to stop trying to repeal an antidiscrimination ordinance by bringing a rock to a city council meeting and inviting him to stone her.

    Donna Jean wasn’t always living her best life, surrounded by sympathetic company like this. When she got out of the military in 1971, the then-raven-haired, then-legally male Donna Jean worked at a municipal airport in Willoughby, Ohio, for 14 years, then at an HVAC and electrical contractor, where she paid her premiums for the company health insurance though she’d been honorably discharged and was eligible for VA care. When those premiums were suddenly doubled, then doubled over again within a year, she had no choice but to collect on her service benefits. Which is how in 2006 or 2007, around the age of 57, she came to walk into a VA clinic in Cambridge, Ohio, a town two hours east of Columbus and an hour west of Wheeling, West Virginia, so inconsequential that even Ohioans have never heard of it. And in a state, one of only a few in the union, that still won’t change the sex on a birth certificate even after a person has had sex reassignment surgery (SRS).

    At that time, Donna Jean needed help. After decades of underdressing (that’s wearing ladies' undergarments beneath one's clothes), and hiding, as much from herself as anyone, she had become suicidal. She had a second wife, and a lot of anger issues. When she went to therapy, everything just came out, all that bottled-up gender dysphoria.

    “I was the first trans patient they’d ever seen in this little bitty VA clinic,” she says. But: “They bent over backwards to take care of me.”

    Donna Jean’s doctor in Cambridge asked her for help helping her. Did Donna Jean have any resources, research, or websites she could recommend? The doctor read everything diligently. She did research of her own, too, so she could prescribe hormones correctly. The rest of the staff seemed to be equally keen on educating themselves. “I assume if you’re here, there’ll be more people behind ya,” DJ says they told her. DJ says, “We learned together. It’s been outstanding for me.”

    She moved to New Orleans in 2010, for a relationship. The VA has been equally amazing here. At least.

    Pamela, to Donna Jean’s right, is a transplant too. She moved to outside New Orleans from Shreveport, some five hours toward the northwest corner of the state, just last fall, specifically to get treated at this VA clinic. She sees the same doctor Donna Jean and everyone else at this table sees: Dr. Jamie Buth. Bobbi W. comes here for that, as well, all the way from Alabama, 190 miles each way, every Friday.

    “You can’t buy better health care anywhere,” Bobbi W. says. She’s got curly dirty-blonde hair and a skirt-and-blouse set. “I’ve been treated with respect.”

    “The VA took an interest in me and cared for me,” Caroline says. “They supported me in my transition 100%.” She says many times, with a voice that’s been feminized with the help of a vocal therapist that the VA has provided for her, “I feel like the VA saved my life.”

    Of course, it wasn’t always this way.

    The reason Bobbi W. started coming here all the way from Alabama 10 years ago is because her experience as a transgender veteran was more the unfortunate type you might fear.

    Where Bobbi lives, the closest VA is in Pensacola, Florida. When Bobbi started going there as trans in the ’90s, the doctors she was assigned to, they would not touch her. They literally would not put their hands on her. “The Gulf Coast VA in Pensacola, anything that deviates from normal is not accepted there,” she says. She says at one point she saw a urologist who told her that she needed a psychiatrist, not a urologist — or to be committed to a mental hospital. She says she waited all day another time with a urinary tract infection, and when she filled out a comment card to complain, the director of that VA called her after to say she couldn’t blame his system for something that was seriously, drastically wrong with her. (In response to a request for comment on these specific allegations as well as the current state of trans care at Pensacola, Public Affairs Officer of the Gulf Coast Veterans Health Care System Mary Kay Gominger wrote, “Gulf Coast Veterans Health Care System is committed to caring for all Veterans regardless of their self-identified sexual orientation. In 2014, GCVHCS met all of the Core Four criteria for LGBT Healthcare Equality Leader status from the Human Rights Campaign.” Comment from the director himself was requested but not provided.)

    In 2003, two transgender veterans named Angela Brightfeather and Monica Helms founded the Transgender American Veteran’s Association (TAVA). They’d been hearing that trans care at the VA was unreliable, and TAVA’s goal was to hold the Veterans Health Administration to treating all transgender veterans “with courtesy and dignity ... as the first-class citizen that you are,” per the organization’s pledge. Back then, with no policy directive in place, it was up to individual clinicians to choose how to act; trans vets never knew if the doctor to whom they happened to be assigned at the clinic coincidentally closest to their house was going to treat them kindly, or treat them at all. There was no formal prohibition against treating trans people, but there was one against SRS — not to mention against transgender people serving in the military — so different VAs were interpreting differently what that meant for their responsibility as health care providers.

    “We found out through other trans veterans that there was inconsistency between VAs and how they treated trans people,” says Helms, co-founder of TAVA and its president for 10 years. Donna Jean, after all, received her excellent care in rural Ohio; Bobbi W.’s in Pensacola was a constant source of insult and distress. As soon as TAVA was formed, “we began the process of letting the VA know what the problem was,” Helms says. But these were Bush years. “At the time, there was an administration that didn’t want to listen to anything we said. It was very hard to approach the VA about anything.” TAVA got no response. Helms surmised the VA’s strategy was that “they figured if they ignored us, we’d go away.”

    In 2007, TAVA launched a large online survey of trans veterans about the care they were getting. The National Center for Transgender Equality (NCTE) helped publicize it. The results were compiled into a white paper by the Palm Center, a public policy outfit that specializes in gender, sex, and the military. The report showed that of the 827 participants, only 29% used a VA hospital for health care; 10% of those reported being turned away because they were transgender. More reported being disrespected and discriminated against, with providers cussing them out or lecturing them on “brave real men,” et cetera.

    After the paper, and an incessant calling campaign orchestrated by a trans civilian mariner in the Navy named Nicole Shounder, and a coalition between TAVA, NCTE, and trans lawyers — and an administration change with the election of President Obama — a policy was finally drafted.

    In 2011, the Veterans Health Administration issued to all of its facilities nationwide a transgender health care directive, “establishing a policy of respectful delivery of healthcare to transgender and intersex veterans who are enrolled in the Department of Veterans Affairs (VA) healthcare system or are otherwise eligible for VA care,” by NCTE’s own description. Reissued in 2013, it forbids discrimination. It mandates confidentiality and the provision of all transition-related medical needs excluding SRS, but including hormones, health screenings, and therapy. It helpfully defines words like “sex,” “gender,” and “transgender,” and an addendum in the 2013 edition answers such frequently asked questions as “Is transgender the same as being ‘gay’ or ‘lesbian’?” (“No.”)

    “It was not exactly what we wanted, but it was far better than anything so far,” Helms says. “It went out to all VA facilities. Two days later, we started getting emails from trans veterans all around the country saying, ‘It works.’ It was helping them.”

    Here are some of the fruits of that labor, at Mandina’s Restaurant on Canal. These eight women who participate in the group, as well as more than 30 other transgender veterans at the New Orleans VA, receive gender and mental health counseling, hormone therapy, blood work, not SRS but the evaluations needed for SRS, post-operative SRS care, and voice therapy, all at their military service–connected health provider. Plus the group itself, which is led by a couple of VA social workers. There are more than a dozen official VA groups like it in the United States, plus additional less formal ones that meet at or through the VA. And thousands of other trans veterans are also the beneficiaries of the above "cross-sex" treatments, nationwide.

    When the VA notified all of its facilities of the new trans-care directive, it also sent talking points and explanations. It gave live presentations and trainings. Those were taped and “archived in the VA web-based educational platform so they can be accessed at any time,” says Michael Kauth, director of the LGBT program for VA patient care services, which is a thing — a thing that grew out of the introduction of the trans directive, which created the necessity for a formal office to oversee it. There are yet additional VA LGBT trainings accessible to the public online, outside the VA firewall, “because we had so many people from outside the VA asking for access to training we were doing within the VA.” The organization also offers trainings to VA clinical teams interested in becoming transgender-medicine specialists. Twice a month for seven months, interested parties teleconference with experts, the most intensive such training within any health care organization that Kauth knows of. “We are the leader in providing training and transgender care among health care systems,” he says. Proudly.

    Not that there aren’t still “issues,” as even Kauth acknowledges. The system is massive, and it is not yet 100% consistent. (The Pensacola director who told off Bobbi W., for the record, is still a director, though at a different VA medical center.) One of the reasons Pamela Raintree moved to New Orleans so she could be treated by Dr. Buth was that her treatment, post-directive, was still rough in Shreveport. Things were indeed better after the Obama administration took over and the trans directive was in place, but it still “wasn’t perfect” — was “far from perfect.” She says she could not get the level of cooperation in Shreveport that the vets in New Orleans were getting with Dr. Buth.

    When Pamela started going to the Shreveport VA in the late ’90s, it wasn’t everyone who worked there that was a problem. She had an appointment with one endocrinologist who “was bending over backwards to help” her. But he was a cancer specialist. He didn’t know what he was doing with a transgender lady, so he switched her to yet another doctor who didn’t know what to do, but “we learned together.” Certainly it was better than what Pamela had been doing before, anyway, which was getting her hormones by buying birth control pills off sex workers. Unregulated, unmonitored hormone use is dangerous; plus, when she could afford it, she was dosing herself with a month’s worth of pills in a day, “so I had to know a lot of hookers.”

    Outside of those two doctors, though, “I got called everything but a human,” Pamela says. One doctor refused to look at her genitals. Another questioned her loyalty to her country. That latter situation was post-directive. (The public affairs officer of the VA medical center in Shreveport, Shannon Arledge, said in an emailed response, “The incidents reported are not acceptable. Our medical providers deliver services and utilize techniques that are consistent with VHA guidance and the patient’s health care goals. Providers deliver care in a manner that is equitable, consistent, accessible, respectful, and ensures continuity and quality. It is the responsibility of each provider to provide treatment within accepted standards of care.”)

    But activists and administrators alike agree that, across the board, things are improved. “Generally, yes,” TAVA’s current president, Evan Young, says. “But you still have some people in the system that have their biases. Just that one person can make your life hell. It needs to be standard across the board.”

    “The VA has come a long way in the last four or five years,” Donna Jean says. Though she never had a problem in any year at any VA, she’s aware of the problems of others, from this group and from Facebook groups — Transgenders That Served, Transgender American Veterans Association, Trans-Veterans. She thinks it’ll only get better and more consistent in the future. There is an enormous new VA hospital under construction in Mid-City New Orleans, 1.6 million square feet on 30 acres, to which “people will come from far and wide to go,” she expects. Her group has had people come not just from Alabama but from Mississippi, too, to attend.

    But hopefully someday, they won’t have to. “I was so surprised to hear how different people’s experiences are at the VA,” Donna Jean says. “They’re trying to standardize it now so you can be anywhere and get the same treatment. It looks like they’re doing it.”

    This morning in group, there were several topics of discussion. Though it does have two social workers at the helm, the meeting is informal; people can bring up whatever they want. Donna Jean doesn’t always love the topics group members pick — the conversation can get too manly, in the worst way, for her taste, when it turns to how many "gooks" someone or other killed in ’68. (“I’m like, ‘Guys. You need to get past that.’”) But she is open, patient, and compassionate with essentially everyone she meets, whether outside a support group’s safe space or in it.

    She’s very aware that she doesn’t have many of the problems others in the group do. She’s already worked through her war issues in therapy. She and her second wife got divorced when she transitioned, but they’ve made their friendly peace, and what living family she’s still got accepts her. She has a new partner, a woman named Lizzie Jenkins. They’re both retired. Donna Jean’s extremely busy and active in the community via Louisiana Trans Advocates, an organization she helped found that runs support groups, which she and Lizzie personally lead in New Orleans and Baton Rouge and attend events for all over the state. She also speaks to university classes because she and Lizzie like to spread awareness and combat stigma. Plus, they really like the way that they can, from the front of the room, see all the college men in the seats unconsciously put their hands over their junk when the discussion turns to sex reassignment surgery.

    When it happens, DJ and Lizzie point out to the boys that they’re doing it. Then the boys spread their arms back out, draping them all over the backs of the chairs around them, reclaiming their full, rightful male space.

    Donna Jean is the happiest she’s ever been. She often hums cheery tunes to herself as she walks around town. At this point, for her, pretty much the main difficulty of being a trans woman is being precisely that: a woman.

    “You automatically lose 40 IQ points in people’s eyes” when you go from presenting as a man to presenting as a woman, she says. Donna Jean identifies just being a woman as for her “the worst thing about being trans” (though when she says this in front of Lizzie, who is also trans, Lizzie interjects: “Aside from losing your job and your family and bankrupting yourself to pay for surgery”). “It’s like being a foreigner,” Donna Jean says. “People talk to you like you don’t speak English. Louder, and slower.” Donna Jean realized she was truly a woman in the world’s eyes the day she went out to her car to refill the windshield-washing fluid and the moment she popped the hood, three men magically appeared. Realizing that the only way these heroes would accept that the little lady knew how to fill her own fucking washing fluid was to tell them that she had for many decades had a penis, she felt no choice but to pretend to be grateful.

    Don’t even talk to her about what happens when she goes to the mechanic. Or tries to open doors for herself. Even Caroline, the blonde with the matching blue eyes and nails, was stunned by the level and amount of condescension she is now subject to, though before her transition she had witnessed already that life as a woman was no picnic — when she was in service, the military wasn’t just for boys anymore, and some of the women alongside her were harassed, and badgered, and called names. It broke her feminist heart then, but she knew it was dangerous for her to say something and draw attention to herself that way. Still, having seen the difference gender makes was different than knowing it, the way she experiences it every day now, the lack of respect, the low standards, how everything — everything — but everything — is overexplained to her all the time.

    “This socialization is so hard,” Donna Jean says, “because women are not respected. I had to revoke my white-guy card. When you’re a man, everything is easy, even if you’re an idiot.” She had to learn the hard way that when you’re a woman, even if you’re not an idiot, you are treated like one. She does point out two perks of modern womanhood that she’s noticed, though. One is that if you’re alone at the grocery store and you smile at another woman’s baby, the woman won’t look at you sideways and put herself between you and her offspring, and might even hand the infant right to you.

    The other is that aviator sunglasses are in for ladies now. So Donna Jean can wear her old shades like back in the Air Force days and look as badass but as simultaneously femme as she pleases.

    But not all trans women are nearly so lucky as to have to deal with only (only!) regular female problems. Often, they have trans problems on top of female problems. Like, for example, Caroline.

    Today in group, the veterans spent some time talking about religion. Donna Jean doesn’t have any conflicts on this front as a Unitarian Universalist, where the only rules (as she describes them) are “breathe, be ethical, don’t be an asshole” and where there are both other trans members of the congregation and a trans minister. But Caroline is a born-again Christian, and she talked about that again in the session today. Her wife of 21 years was the one who brought her into the evangelical fold, partly as an effort to allay the gender “issues” they’d discussed since their second date. (They’d had to discuss them then, that early in their relationship; then-male-presenting Caroline had not anticipated things getting to the point of clothes coming off on that date, and had been underdressing that night.) In 2009, she started taking hormones in secret. In the ensuing years between then and when she had GCS — gender confirmation surgery; that’s her preferred term, over SRS — in January 2013, Caroline’s wife took her to counseling with their pastor, who was convinced she could be fixed with more manly activities, more focus on her marriage and family, and god.

    Caroline is no longer welcome in her church. Or in her house — she and her wife are divorced now. Caroline is utterly heartbroken over it (“I love her,” she says of her ex), and in addition to her spouse and her church, she lost her children, only one of whom recently started talking to her again. And her military job. And with it, her pension.

    Caroline had served 18 years of a 20-year National Guard career when she was discharged for being trans. At the time, she was in the midst of getting processed for an honorable medical discharge due to post-traumatic stress disorder. In 2004, she crewed Black Hawks in Iraq for a year. She transported spectacular amounts of cash — entire Black Hawks packed with cash — through the air while people lobbed bullets, missiles, and rocks at her from the ground. Her unit transferred Saddam Hussein from American to Iraqi custody in a helicopter. Then a few months after she got back home, in 2005, Hurricane Katrina hit her state, and the National Guard was deployed. “It was really cool rescuing people rather than killing people,” she says. But it was really hard to see New Orleans like that. It had also been hard to see an American convoy on the ground in Iraq under attack one time, when she says she watched from the air, unable to get in there and offer support because of the VIP Caroline’s crew was transporting on board.

    One of the few POWs of that war, Matthew Maupin, was captured that day. Later, he was executed.

    In 2007, Caroline was diagnosed with PTSD. It was too severe, the National Guard said, for her to deploy again. In 2011, she hit a deer with her car, and she came completely undone. Her nightmares were constant, debilitating. It was while her paperwork for medical discharge was being processed that the Army noticed a little something else in her medical chart: She was transitioning.

    Transgender people are not allowed to serve in the United States military. There was a hearing. The VA doctors said that Caroline had PTSD, for real, that it was bad and had gotten worse over time. In her dreams, mortars fell constantly on her in Mosul. Or, she hit the deer with her car, but when she got out and circled around the front, it wasn’t the deer that lay there dying, but Matthew Maupin. Caroline’s lawyer argued that since the Army broke her, the Army was responsible for her, trans or not. The Army counsel aggressively questioned the validity, much less severity, of any ongoing PTSD problem. In 2014, she was given a general discharge with the code of "moral or professional dereliction." (She still gets VA benefits because the National Guard discharged her after her Iraq deployment, as is common when switching jobs or contracts; that honorable discharge makes her eligible for VA care.)

    Now she struggles. She loved serving. Today before lunch, in group, Caroline talked a lot. Today maybe especially, she is struggling, because four National Guardsmen died in a Black Hawk crash a couple weeks ago and that was her unit, her guys. Earlier this week she went to one of their funerals, and at lunch she continues talking about how it was “awkward as hell.” Everyone there had “never met Caroline.” They’d seen her only dressed as a man named Rob — Zombie Rob, Caroline calls him, for the way he had to tune out and shut down and present this shell of a person the people around him wanted him to be.

    Despite that. Despite all the struggles. Being Caroline is still better than being Zombie Rob. Even though Caroline is terrified that she will not be able to find someone to love her. As beautiful and talented as she is, almost everyone who loved her as Rob has bailed.

    Her company where she holds a civilian job as a medical imaging specialist stood by her, the only people aside from her doctors at the VA. By accepting and helping her become who she was — that’s why she says the latter saved her life. “I was gonna die anyway,” she says, referencing a deeply suicidal period she went through as Zombie Rob. “So,” even though she’s struggling, “this is all bonus.”

    Last year, there was another face in this trans veterans support group. “We lost a girl,” Donna Jean laments. “Just this last year, she just killed herself. There’s so much on some of these people that it’s very hard.”

    Donna Jean regularly and easily slips statistics into conversations, like that 41% of trans people try to commit suicide at some point in their lives. For trans people who have been rejected by their doctor for being trans, that number is 60%.

    “If not for Dr. Buth, I would’ve suicided out by now,” says Stephanie Lee, the vet who hooked up with other soldiers in Vietnam. “A lot of trans people get very despondent after a short period of time because of care.”

    Dr. Jamie Buth knows what’s at stake when trans veterans come to her. When we meet several days later, at a coffee shop on her lunch break, she explains between bites of a sandwich how, besides that she would like to give high-quality compassionate care to all of her patients regardless of her own personal background, she does know what they’re going through. She had two children and a wife of almost 15 years when she started going to support groups for the gender-nonconforming in the ’90s. She was practicing medicine near Chicago then, where thankfully such groups existed; she knew since the late ’80s that she didn’t identify as male, and those meetings in Chicago once a month were “a chance to feel the wind on my face.” When she moved her family to New Orleans for a job with the VA in ’96, she’d already started getting electrolysis and taking hormones. Her wife divorced her pretty quick.

    But the VA turned out to be as much of a refuge for her as it’s been for her patients. When she, both terrified and excited, had a meeting with VA leadership in 1998 to explain that she was going to transition, “everyone was receptive and supportive.” There was only one guy on staff she became concerned with, reaction-wise, when he started skulking around seeming like he had something on his mind about it, but it turned out he just wanted to ask Dr. Buth if he could have all her old suits.

    “It’s New Orleans,” she says, shruggingly, of this level of acceptance. “Many people in the [VA] administration were LGBT-friendly.” Unfortunately, that didn’t make them immune to sexism, so when she came back from Thailand, the same person, to the same job, she — like all women and nonwhite males — just “had to start taking more jobs and working twice as hard” to prove her competency. That’s all.

    Two years after Hurricane Katrina, during which she was acting chief of staff for the New Orleans VA and also managed three new community-based outpatient clinics that got set up, Dr. Buth was ready for a break from New Orleans. Also, she wanted to try being chief of staff, rather than service line director for ambulatory and primary care, and at a different VA. But there, outside the New Orleans bubble, she wasn’t getting a lot of second interviews. Her look and her voice, as she describes them, were “not flawless,” so her interviewers in these less progressive towns knew they were talking to a trans woman, and she knew they knew, but nobody knew how to handle the conversation.

    The VA stepped in. Through one of its programs, it flew her to Cincinnati to train for doing job interviews as a trans person. The very next interview, in a rural town in Oregon, she got the job.

    She wasn't gone long before she came back. She had a love interest in New Orleans — a VA nurse, now her wife of five years — and here she provides trans care to some 40 veterans. She thinks the VA’s health care system is the best in the country, even if it still has work to do in improving general care, and trans care, too. Despite all the trainings and awareness campaigns, “I’ve heard people [at other VAs] can be insensitive or mean,” Dr. Buth says.

    Plus, while the current policy is great, it doesn’t go far enough. “I would love to see the VA covering sexual reassignment surgeries, and insurance companies covering it. It would help a lot of people who are suffering.”

    According to Kauth, the VA’s LGBT patient care director, this is not outside the realm of possibility. “VA regulation would have to change and policy would have to change to make that happen,” he says. “Those policies and regulations get reviewed periodically. Certainly the evidence is growing and the movement is growing to make a change. I can’t say it’s been reviewed or would be, but you can see what’s happening. Medicare-Medicaid decided to allow SRS last year, the only trans care the VA still won’t do, and that probably sets the tone for what the rest of the federal government is going to do,” he speculates. “But I can’t speculate.”

    If this happens, it would make the procedures available to more transgender veterans. TAVA’s Evan Young calls the moratorium “backwards”; he’s paid for SRS with his private insurance, and recently found that the VA wouldn’t help him with some of his post-phalloplasty procedures as it considered them “ongoing” rather than “post-op” care. Donna Jean spent all the money she had on her surgeries, and though the VA was there for her before and after, they won’t do the actual surgery: “If you get your surgery messed up, they’ll fix it. They’ll check the scars on your boob job, make sure everything is working and healing correctly.” And though she is very happy, she is broke. Caroline, especially since she is no longer eligible for her pension, made a seriously significant dent in her savings when she went to Thailand, taking out her 401(k) to do it. Bobbi Perry, the vet who used to be homeless (she isn’t now, thanks to a VA program that gets veterans housing through the Department of Housing and Urban Development), was planning to have SRS before Hurricane Katrina, but then had to use that money to survive her displacement from the storm. Living off disability checks, at 65, she certainly doesn’t have the money now, as the cost of SRS can be anywhere from $8,000 to $25,000 for male-to-female transitions, and up to $75,000 for female to male.

    It’s a big burden. It is not the biggest burden, as medical support is far from the only kind people need. Donna Jean, in yet another of her many activist capacities, organizes New Orleans’ Transgender Day of Remembrance. Every November, people light candles in ceremonies around the world for trans people who’ve been murdered in the calendar year, and last year the worldwide list compiled by Transgender Europe called for 226 candles. Bobbi Perry says she almost became one of them a few years ago, when she was jumped on Decatur Street, choked and pummeled by two men calling her a fag.

    “Being trans is horrible for many people,” Caroline says. “Impossible.” The breakups, the judgment, the guilt and hatred from inside and out. “It will be, until acceptance changes.”

    Deanne, one of the women at the other end of the lunch table from Caroline that Friday after group, got fired from her civilian job as a computer technician in 2004 when her transition started showing. Donna Jean’s partner, Lizzie, was fired from two different architecture jobs. Deanne’s partner, Stephanie Lee, sitting next to her, says the only time being trans wasn’t hard was in the middle of the Vietnamese war zone.

    “In country,” she says, “it’s fine. Things change when you’re dodging bullets.” At lunch today, she’s got a tanned face and long, gray-and-brown hair. She’s wearing a pink shirt, and talks with the voice of a person who’s smoked a shipping container’s worth of cigarettes in her life. “In country, male and female doesn’t matter. You get over there, you lose yourself very quickly.”

    She says everyone in her unit knew her gender identity, and it caused zero problems. Donna Jean seems shocked by this admission — she heard of that sort of thing happening but “was way too scared” to come out like that herself. But Stephanie was always out, from the time her mama was taking pictures of her in nightgowns as a child in the ’60s. She still gets together with some of her war buddies every once in a great while. And they still get along fine. “I relate more to ground troops — as opposed to people who flew airplanes above us,” she says, leaning accusingly in the direction of Donna Jean, who looks up coyly and bats her eyes.

    “My problem was in the States. In America, it’s hard to get people to accept you as a person, much less as trans,” she says. “If we got loud and crazy in here” — she nods toward the rest of the dining room — if these trans veterans drew attention to this table, “most of these people would not understand us.”

    It’s exhausting, never knowing whether you’re going to be accepted. It can be a terror. It makes up a lot of the conversation in group. Although, sometimes, the women have found, people will surprise you in a good way.

    Take the current situation of the other Dee, the Marine Corps veteran who’s just started transitioning. (She is “only taking hormones so far.”) She wears her short hair in a more feminine style at group, and increasingly when she goes out for errands, plus makeup and nails. Coaching soccer and at work, she still presents as male. But she’s recently started coming out to some of her co-workers on the offshore oil platform.

    “I’m finding that they’re accepting,” she says. She even told her boss, which the other women encouraged her to do (“If they find out, it’s not good”), and he had no issue. “One guy surprised me — not the guy you’d expect to be OK,” Dee says. “He started inviting me over for beers and bonfires.”

    “Watch those,” says Deanne, who’s sitting across from her. “They’re the marrying kind.”

    Dee laughs, just for a second. She is a very earnest person. She is a divorced parent of four. She loves this group, and is super grateful it exists. The VA, too, where she’s found that though regular care can be below average, “everyone has been so nice and so helpful” when it comes to her trans care. “For regular care,” she says, waving her hand back and forth in the "so-so" gesture, “eh.” She’s had to wait forever for appointments. Once, she says, she was shuffled between four different doctors in just a month and a half. But for trans care, she says the VA has been great, “down to the secretary” she schedules with.

    Donna Jean wishes it hadn’t all taken this long.

    “I didn’t start transitioning till I was 58,” she says. “I had to overcome a lot of testosterone poisoning.” The way the hormone broadened her shoulders. All the hair, and muscle bulk. The hiding, unhappiness, and divorces. There’s a 7-year-old boy, assigned female at birth, in one of her Louisiana Trans Advocates support groups whose parents are going to waylay his puberty with hormone blockers if he still identifies as a male when the time comes. “I wish I could’ve started when I was 16,” Donna Jean says. “It would’ve made all the difference in the world. If I coulda done it when I was 20, my life would’ve been totally different. But it didn’t work out that way.”

    Waiting so long, that’s why she and the other trans vets don’t “blend,” she says, into the female population now, and why their transition was so disruptive to many of their lives.

    She’s really happy for that 7-year-old, though. And that stories like that are becoming more common. She does what she can to help pave the way for them to become more common still. “I came out to everyone I knew in Ohio. They all ask if being a trans woman means I’m dancing in a club in the French Quarter. I tell them, ‘No, I’m the old lady behind you at Walmart buying a shower curtain. We’re just people.'”

    That she can get trans care at the VA is proof that things have gotten better already. “Trans veterans have always been in our system,” Kauth, the VA LGBT director, says. “Social attitudes were changing around trans veterans as well as around LGB veterans, so that helped facilitate VA changes.”

    “Officially we support transgender people,” Dr. Buth says. “On the other hand, there’s just a lot of people who haven’t changed with the times. Not that it’s related at all to transgender, but I heard someone saying on this thing on the news, ‘Well, maybe discrimination against blacks will end once this current generation is dead.’ When I grew up, I didn’t even know [trans] was a possibility. Now there’s a TV show called Transparent, there are people on all sorts of national digestible media, not to mention gay people and everything else. It’s really gone far away from Renee Richards to Bruce Jenner. So things change.”

    The VA managed to — that colossal, slow-moving, bureaucracy-laden system established to serve needs created by the most hypermasculine and heteronormative institution in the world. Until everyone else does, though, the members of the New Orleans VA transgender veterans group know where to find additional support every Friday morning.

    “If not for the VA,” Bobbi W. says, clutching Caroline’s hand, “we wouldn’t have each other.”

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