The Redrawn Fault Lines of Trans Rights Activism

It’s clear: We probably shouldn’t look to the current federal government to protect trans communities—particularly trans women—from sex discrimination.

On Monday—just two days before people honored International Women’s Day, which also reopened conversations about how trans women are often sidelined from discussions around women’s rights—the Supreme Court punted a major trans rights case, deciding to send the case back to lower courts for further consideration. And on Feb. 22, President Donald Trump overturned Barack Obama’s Title IX mandate, which guided schools to protect trans students’ right to access the bathrooms and facilities that match their gender identities.

Kelsey [not her real name], a transgender college student who has not come out, reflected to me on how things have changed since Trump was elected: “The whole world outside feels more threatening. In a lot of ways, I’m glad that I’m not out, and in a lot of ways, the political landscape is pushing me toward staying in the closet.”

The Washington Post Editorial Board put it more bluntly: “The White House just told transgender students they’re on their own.”

In light of this radical rolling back of trans rights, how can we as individuals, and as communities, support one of the most vulnerable populations in the country?  

First, we need to understand the full scope of what’s at stake. The mental and physical health of transgender students is at immediate risk. Transgender hotlines are experiencing sharp spikes in crisis calls. Transgender and gender nonconforming individuals are at exceedingly high risk of depression and suicide, with 41 percent reporting that they have attempted suicide at least once, nearly nine times the national rate, according to the Williams Institute. Moreover, at least seven trans people—all women of color—have already been killed in the first two months of 2017 alone. The future for trans people, in other words, looks increasingly bleak.

Many were looking to Gavin Grimm’s Supreme Court case for hope, as a last chance to override Trump’s action and to expand transgender rights. Yet as was made plain earlier this week, we can’t rely on the courts to solve all of our Trump troubles.

Rather, we need to be proactive. As individuals, we need to examine our own role as bystanders and perpetrators, address our blind spots, and identify where we have influence to drive incremental change.

As a health professional, I’m starting with the healthcare industry, a field that’s currently wildly under-equipped to meet the needs of the transgender population.

Health care access is often a major issue for transgender people. Rowan Lowden, Outreach Director at the trans health care organization RAD Remedy, explained to me that initial obstacles for trans folks include not having insurance, not knowing where to go, or lack of transportation to reach trans-competent health care centers, which may be hours away.

But the challenges don’t end once a trans individual reaches the doctor’s office. Horrifyingly, 19 percent of trans people have experienced outright discrimination by being denied health care service due to their transgender status. Even when a trans person finds a physician who will provide care, some 50 percent have reported having to teach their provider about transgender health care due to widespread lack of training and evidence-based guidelines. Indeed, less than half of medical schools cover sex reassignment surgery and transitioning in their curriculum. According to a study in the Journal of Clinical Endocrinology & Metabolism, 81 percent of endocrinologists, specialists in treating hormone-related conditions, have never received training on how to care for trans patients.

In my own experience, I’ve been disappointed to find that electronic medical records tend to be inadequate for the needs of transgender patients. Often, gender fields are difficult or impossible to change, there is no distinction between gender identity and legal sex, nowhere to list preferred name or pronouns, and no options beyond male and female. For instance:

And even if an office attempts to change gender in their records to match patient’s gender identities, their well-intentioned action may result in incongruences with insurance claims or medication prescriptions down the pipeline, causing coverage to be withheld.

With all of these obstacles, it’s no surprise that 28 percent of trans individuals have delayed seeking medical care due to discrimination and 48 percent have postponed care due to an inability to afford it.

Thankfully, there are at least some organizations working to address these barriers. The National LGBT Health Education Center at the Fenway Institute has created and shared resources like a transgender-inclusive intake form that health care practices can use to address issues in medical records. Specialized health care centers like Los Angeles LGBT Center and the Apicha Community Health Center in New York City provide trans-competent health services to diverse underserved communities, regardless of ability to pay. For those who don’t live in cities with transgender health specialists, RAD Remedy and MyTransHealth are two health startups for trans people—by trans people—that provide a platform for users to find trans-competent health care providers and to read reviews of their services.

It’s daunting. There’s a lot of work to be done—in health care and beyond. As Lowden said, “It’s really hard to do activism at a time like this. It’s really exhausting. For me, for myself, it’s not complete terror. There is hope…but this is also exhausting.”

But rather than get stuck before we even start, what if we find small ways to infiltrate our industries, our workplaces, our schools, and our communities to make this country safe for trans individuals, particularly trans women? Whether that means donating to organizations working toward these goals or asking our HR departments to incorporate gender-neutral terms, let’s start identifying ways to champion causes such as trans rights in our everyday actions.

On my agenda: drive initiatives for inclusive health records, bring additional trans health programming to medical school campuses, and encourage current and future physicians I know to learn about trans-competent health care and seek opportunities to provide care to trans people.

What’s on yours?