Why you should care

Because conventional health care systems are letting trans people down.

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In 2009, Georgie was running out of patience. The transgender woman had been waiting for approval to begin a series of medical procedures that would change her life. To qualify for medical transition, though, the 30-year-old biology Ph.D. student from Tennessee had to jump through an unforgiving hoop: Doctors told her she had to present full-time as female for two years with regular checkups from a therapist.

When she told her doctor that she was struggling to make it through the day, he gave a sympathetic shrug and said, “I can’t change the system.” Georgie told him he wouldn’t have to: She wasn’t coming back. Instead, she launched a Kickstarter campaign. Within a month, she had raised $7,000 from family, friends and internet strangers — enough to pay for her facial feminization surgery. Now, she’s going back to school and thriving in a new city. “Doing this literally saved my life,” says Georgie, who, like many trans people, prefers not to publicize her last name for safety reasons. “I just wish I could have called up my doctor on day one and had it be no problem.”

There’s a growing realization that [transgender patients] can’t wait for the rest of the world to catch up, so we’re taking care of ourselves.

Calum O’Donnell, trans activist, Edinburgh, Scotland

By taking responsibility for her own health care, Georgie joins a growing number of trans people making an end run around conventional public and private systems. Activists are developing “white lists” of doctors and other practitioners who are competent to treat transgender patients, challenging antiquated and prejudicial laws that impact trans medical care and forming international support networks. “This may be the only population of people that has been medically treated for nearly 100 years,” says Ruben Hopwood, coordinator of Boston’s Fenway Transgender Health Program, “but whose treatments are still labeled as ‘experimental’ by our medical regulatory bodies.”

The movement to normalize trans health care has gone global. In France, members of OUTrans, a Paris-based advocacy group founded in 2009, accompany other trans people to doctors’ appointments, help decode blood-test results and distribute health brochures. “Practices vary wildly across local health trusts,” explains Max, the secretary of OUTrans. “Some practitioners routinely prescribe hormonal treatments to trans patients, while others claim to lack the expertise to undertake any clinical duty when faced with a trans person.” The latter experience is so common that it recently went viral with the hashtag #TransHealthFail — trans people tweeting about being denied unrelated medical treatment when their doctors found out they were trans.

When it comes to equal rights under the law, not every country is as retrograde as France, which has some of Europe’s most draconian practices preventing access to care. Iran isn’t exactly known as an LGBTQ playground, but it has become one of the world’s leaders in trans-related surgeries, in part because gay people have been encouraged to opt for gender transition rather than pursue same-sex relationships. Over the past 10 years, even socially conservative China has seen an uptick in gender reassignment, according to the Beijing LGBT Center, though procedures are expensive and restricted to the upper class.

In the U.S., where the American Medical Association has guidelines specifically for transgender care, Hopwood’s Fenway program is the biggest federally qualified health center for LGBTQ people. It’s so well known to the American trans community that many patients relocate to Boston for treatment. While Fenway’s health care standards are a beacon of safety for many patients, Hopwood sees education and research as the center’s two most important functions. “Until there’s widespread medical education for transgender and nonbinary people,” he says, “it will be challenging and slow to build up the comfort and skills necessary to have many Fenways across the country.”

Over the past two years, Hopwood has noted some improvements in mainstream health care for transgender people. More insurance providers are removing clauses that exclude trans clients from policies and are covering more trans-related treatments. Still, there’s a lot of red tape that discourages patients from going to the doctor — for anything, not just transitions. For example, it’s logistically tricky — and in some places, impossible — for trans men at risk of cervical cancer to get a Pap smear if their ID reads male.

These indie efforts to obtain basic health care sometimes come at a prohibitive cost. In the U.K., the National Health Service pays for hormone therapy and many gender-affirming surgeries, but patients currently endure waiting times of more than a year — and that’s just for a first appointment. In response, some patients turn to private practices, but the combination of appointments, blood tests, hormone replacement drugs and certain surgeries can cost more than £10,000 ($12,677). In response, charities like Action for Trans Health raise money for people to pursue a more timely transition in the private sphere.

While cisgender people can now turn on the TV and identify with Caitlyn Jenner, representation in the media doesn’t ensure good health or save lives. Simply put, says Calum O’Donnell, a trans activist based in Edinburgh, Scotland, “there’s a growing realization that we can’t wait for the rest of the world to catch up, so we’re taking care of ourselves.”

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