Table 6.
Illustrative Quotes about Three Healthcare Issues Most Prioritized in Summits
| Insurance coverage for therapy and trans-related care: | |
| • | “My insurance denied coverage of my therapy because of my gender dysphoria. Fortunately, my hormones are covered because of the way my doctor codes it, but coverage for my surgery was denied. I saved and paid for that myself.” (Trans man in his 30’s) |
| • | “Even with Medicare [which is supposed to cover it], I’ve had issues with getting coverage for HRT. I had issues with gatekeeping by an endocrinologist who wanted a referral from a psychiatrist instead of a therapist. He also wanted me to pay despite Medicare covering the procedure, because he didn’t believe Medicare would pay for it. The second doctor I went to didn’t give me any referral issues but did ask me to pay. The doctor I finally went to was backed up but didn’t need a referral and was able to bill Medicare.” (Trans woman in her 50’s on disability) |
| • | “I was denied coverage for hormones until my gender marker was changed and I still can’t get mental health care through [my insurance provider] because they pay so poorly none of the few available gender affirming therapists will take it.” (Trans woman in her 40s) |
| Availability of providers willing to provide/capable of providing transition care: | |
| • | “I waited for 10 years to transition because I didn’t know of anyone who would prescribe hormones. I finally found a therapist who knew [doctor who provides HRT] and was able to start on T.” (Trans man in his 30’s) |
| • | “I bounced from therapist to therapist just to get a letter to get hormones. I eventually went to [a trans clinic out of state 5 hours away] to get hormones.” (Trans man in his 30s) |
| • | “It took me five different attempts after months and months to get an appointment with a therapist [to talk about my gender dysphoria]. There was no psychotherapist in my [small rural town] so I finally went to the [community mental health center] in [larger town]. When I put “gender dysphoria” on the paperwork, the office staff just said ‘Well you aren’t going to get help with that around here’ and they didn’t refer me to another provider.” (Trans woman in her 40’s) |
| Need for provider sensitivity/education/cultural competency: | |
| • | “I waited three months for an appointment with a highly regarded eye specialist for treatment of an ongoing serious eye condition. When the doctor saw me, he said he wasn’t going to treat me and told me to ‘get out of’ his practice. I drove 10 hours from [rural hometown], only to be dismissed by this specialist.” (Trans woman in her 40’s) |
| • | “Doctors often ask about my transition when it’s totally unrelated to the care I need from them that day. They ask me in all kinds of ways. ‘Where are you in your transition?’ ‘Have you had all your surgeries?’ It’s like they’re saying ‘Reassure me that you are who you say you are or I won’t believe you’re really a man.” (Trans man in his 30’s) |
| • | “I’ve spent a lot of time in the mental healthcare system starting at the age of 12 after attempting suicide. I was in residential care in a religiously affiliated facility where the staff were openly homophobic and transphobic, and I was treated poorly. I was a patient there multiple times over a span of years. They justified their ineffectual and often damaging treatment by noting that their religious beliefs mandated it.” (Trans man in his 20’s) |
| • | “When I went to the emergency room for a suicide attempt they put the wrong gender (F) on my arm band even though I had already legally changed my name and gender with my insurance. When I tried to get her to fix it the clerk rolled her eyes and blew me off. Then, when I told the doctor I had gender dysphoria he said, ‘I don’t know how to deal with this’ and made notes and left the room. Later when I was institutionalized in [mental healthcare facility] they kept me in their lobby area for what seemed like hours, then finally moved me to a room in the female wing. When I pitched a fit, they pulled me aside and asked about my genitals. They finally put me in a room by myself. Then later, when another trans guy was being admitted they actually talked about his personal information with me, which was a HIPAA violation, and ended up putting us in a room together. They also called my partner and talked about me using my deadname.” (Trans man in his 20’s) |
| • | “I had the doctor in the emergency room say ‘shame on you!’ for not telling them I’m trans. I didn’t tell them when I was admitted because I didn’t think it had anything to do with the problem I was there for and I was afraid of how I would be treated. I didn’t think it was medically necessary to tell them. His attitude certainly didn’t help.” (Trans man in his 30’s) |
| • | “I’m not out yet in [small rural hometown] and I can’t go to a dentist locally because they all want to see your med list which would “out” my status/identity.” (Trans woman in her 40’s) |