Transgender individuals seek validation from society for the gender they know they are. This search for validation is one of the most important motivators for an all too often ignored population. Even individuals with family support for their transition and the financial resources to transition in socially and medically approved means face immense challenges. For transgender persons without adequate medical insurance or a support network, transitioning is a truly daunting task.
Silicone, street hormones, and trial-and-error too often form the transition regimen for individuals without the access to health care and the thousands of dollars needed to pursue gender transition in compliance with the World Professional Association for Transgender Health’s Standards of Care. Just a discussion of the risks of silicone injections is not helpful. The real issue is affordability and availability of medical services and access to supportive counseling for a healthy gender transition.
For those who do not question their gender identity, it is hard to imagine what transgender persons go through to garner society’s validation. Many transgender persons are so driven for validation from society that if a potential partner approaches them for a high-risk but validating behavior, the transgender person is too often unable to negotiate a healthier alternative.
Gender is social, not sexual. A transgender person needs to be accepted by the bus driver, by the store clerk, by everyone he or she comes in contact with. And trans people work very, very hard to elicit that acceptance.
The transgender person knows that they must both look like and act like the gender they need to be. Looking the part means cross-gender hormone therapy—estrogen for males to female, testosterone for females to male. Hormones work quite well, but they take a while, especially to re-form the male body after the onslaught of testosterone during puberty.
Some transgender people, however, need more immediate validation, while others cannot afford the cost of a long-term hormone regimen. Individuals without access to supportive psychological counseling to help them cope with the stress of transitioning, or those without the insurance or financial resources to pay for hormones, often turn to less-expensive street drugs or alternatives to hormones, like silicone injections, to re-shape their bodies. The risks of street hormones or silicone injections, while significant, are not the issue. The issue is access to affordable health and mental health services. This is a public health problem.
Programs like those at Howard Brown Health Center in Chicago, where Lois Bates works (see Body and Soul sidebar), are needed to cut the risks faced by the transgender population. Because of the sliding scale charged, some trans women pay less for their transgender medical care than many others who have insurance will spend on co-pays.
Cross-gender hormone therapy can run from $150 to $200 a month and a battery of needed twice yearly lab tests can cost $1,200 a year. Insurance will sometimes pay for the tests but not all of them, especially the ones testing for male and female hormone levels in the same person. The cost can be significant even with insurance. Those transgender persons deciding to seek sex reassignment surgery (SRS), typically have to foot the entire bill without any insurance payments, a bill that can easily cost more than $25,000.
In spite of the challenges, the rejections and the costs that transgender people often tell about in their stories, they typically end their story with “I would not have done it any other way.” Transitioning is a celebration of who you are.
Getting validation, a fancy way of saying what the transgender community calls passing, is not just about how you look physically. Gender-appropriate deportment and mannerisms will overcome many aspects of gender-incorrect physical traits more often than we think.
The path is very hard work, but for many of those who persevere, there is the finality of achieving their goal—gender recognition. Several Websites catalog the stories of successful—sometimes very successful—transgender persons. These are stories of MTFs [male-to-female] and FTMs [female-to-male] who are doctors, lawyers, police officers, actresses, professors, cosmeticians, investment consultants, etc.
But even for these very successful individuals, as for all members of the transgender community, discretion is always needed. For the gay community, it’s healthy to be out and to be open about who you are. Being out doesn’t work as well for the transgender community. Transgender persons want to be validated most of the time for being women or men, not necessarily for being transgender. It is not helpful, given current societal acceptance, for a transgender person to be out.
The rejection transgender persons face in society can even impact individuals with good jobs and access to health insurance. Working transgender persons sometimes forgo insurance coverage, even when available, for fear of negative reprisals from their employer who many times has access to insurance claim details. Transgender persons have reported losing their jobs just for filing a health care claim. Work-related issues are beginning to lessen, though. Some employers even cover the cost of SRS [sexual reassignment surgery] for their transgender employees. One transgender person who had a particularly bad time when she transitioned on the job some years ago recently said that her former employer has dramatically changed their policies, “to ensure they have access to the high-tech talent pool they needed.”
With all the discussion about transitioning, the long-term dynamics of the transgender experience often gets lost in the intensity of making the initial gender change. Transitioning is a life-long activity, and hormone therapy needs to be continued even with SRS. Transgender persons must take an active interest in their own health care. Transgender persons must ensure that medical providers know of their gender history, since many diseases and medications are sex specific (transitioning does not change a person’s sex chromosomes.) Providers, even your dentist and your chiropractor, must know your genetic sex. This candor with health care providers is sometimes hampered by a transgender person’s previous interaction with the system. Too many stories circulate of providers with a less than supportive attitude towards their transgender patients. A negative interaction, especially if repeated over time or with different providers, can create a reluctance to seek medical help until too late.
Just about every culture we know has references to transgender persons. Ancient Roman society had a place for gender expression. Indigenous American cultures did too. French nobleman Chevalier D’Eon, and counselor to King Louis XV, transitioned “on the job” in court from monsieur to mademoiselle! More recently we have seen films such as the English production from the late 1990’s, “Different for Girls,” and the popular American film, “TransAmerica.” Even that icon of interior décor, IKEA, produced an ad for the European market featuring a transgender person (you can still see this ad, “Redecorate Your Life,” at www.commercialcloset.org).
Transgender persons are a challenge to one of society’s most fundamental assumptions. They are an underserved population, and are susceptible to high-risk behaviors but, above all, they are just people wanting to be themselves. e
Pamela McCann is an administrator and advocate for the Office of LGBT (Lesbian, Gay, Bisexual, and Transgender) Health at the Chicago Department of Public Health, and herself a transgender woman.
Body and Soul
by Enid Vázquez
With all the discrimination, including that from medical providers, standing in their way, transgender individuals still seek the body that satisfies their soul. If clinics and pharmacies are unwelcoming, and costs prohibitive, treatment is readily available on the streets.
“I’ve seen people with cheekbones put in, not necessarily by doctors,” Chicago nurse practitioner Bethsheba Johnson says of the transgender male-to-female (MTF) patients she lovingly calls her “divas.” (See page 20.)
She’s heard about the backrooms in unsterile conditions, where injections of free (not encapsulated) silicone rounds hips, butts, and breasts. She hears of the “parties” where transgender women gather to get their injections, one after another.
“It scares me,” said Johnson.
According to the treatment protocol produced by the Tom Waddell Health Center (TWHC), which focuses on transgender care as part of the Department of Health in San Francisco, “Invasive procedures such as silicone-like injections were available underground, in cases creating severe local tissue damage. We have patients who have been permanently disfigured by these injections, which often mix industrial grade silicone and/or other substance such as paraffin and oil. …The immediate dangers of these injections include: soft tissue infection, risk of contaminated needles transmitting disease such as HIV, hepatitis, or MRSA, and foreign substance reaction. The long term dangers include: recurrent inflammation, migration of the foreign matter from the injected site, disfigurement such as nodules, granulomata, and pain syndromes.
“Treatment is palliative [relieving pain and discomfort]; there is no effective way to remove unencapsulated silicone from body tissue,” the protocol continues. “Silicone injections into breast tissue make mammograms ineffective. We see the damaging sequelae of silicone and other substances on an infrequent but regular basis.”
“They are so desperate,” said Johnson, who provides psychosocial care. “They want immediate results. They don’t want to take a couple of years to get the curves. They want them now.”
In her presentation “Trans 101: Misunderstood and Misinterpreted,” transgender Chicagoan Lois Bates (see profile on page 49) explains that, “In the trans community, appearance and pass-ability is very important. It is very important to maintain body image and it is valued above other important aspects of life. The body image process may vary due to an individual’s economic ability to support a regular regimen or see an accredited professional. Some regimens and procedures may be covered by insurance or government aid. Individuals with private insurance have an easier and faster path of transitioning. Individuals with no insurance and lower economic ability may seek medications and regimens from black market sources.” |
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