I was Denied Necessary Healthcare Because I’m Transgender
In late May, 2019, The Department of Health and Human Services under President Trump announced plans to remove “gender identity” from the Affordable Care Act’s anti-discrimination language, essentially leaving transgender patients subject to legal discrimination in healthcare and insurance coverage.
While I and every other transgender and non-binary person in my community is deeply frightened at the potential of such a move, facing discrimination from doctors and insurance companies is actually nothing new for us.
If she ain’t broke, break her
In February 2018, a rheumatologist in Grand Rapids, Michigan refused to continue to treat me with Remicade, the biologic medication that suppressed my immune system to mitigate the effects of an auto-immune disorder called psoriatic arthritis.
I had been treated with Remicade for 6 years up to that point by my doctor in Austin, Texas. I had no side-effects from it, no complications, and nearly 100% control of my symptoms through the use of Remicade. It was completely successful in treating my psoriatic arthritis, a condition completely unrelated to being transgender. Millions of cisgender people have psoriatic arthritis, too.
In case you aren’t familiar with the terminology, a cisgender person is simply someone who has no conflict with their assigned-at-birth gender. To put it another way, it’s basic taxonomy; if you’re not transgender, you’re cisgender. Feel free to sort yourself into the appropriate category.
The difference between cis and trans healthcare
When I was on Remicade to treat my psoriatic arthritis symptoms in Austin, I hadn’t yet come out as transgender, or transitioned. As far as my doctor knew, I was a cisgender person. But, when I moved back home to Michigan so that I could recover from depression, come out, and transition, I had to establish care with a new rheumatologist before I was able to accomplish any of those things. My new doctor, who had no reason to believe I was anything other than cisgender, happily and almost unquestioningly continued the successful treatment plan that my previous doctor had put in place.
That is, until he found I’m transgender.
When my new doctor received official, medical paperwork from my primary care physician informing him of my transgender status and the relevant details of my gender transition care, he sat me down in his exam room, alone, and told me that he was “angry” that he found out that way — by documentation and a professional letter from another physician — instead of me telling him “personally.”
He then berated me for my “life choices” and threatened me with death by Remicade because I was going to “go off and have all those surgeries without telling” him.
Remicade is an immune-suppressing treatment, which makes me much more susceptible to infection. As such, if I have a cold or a cough, I can’t continue treatment until the illness has been clear for five days. If it’s something more serious that requires antibiotics, I can’t get another infusion of Remicade until I’ve been off of the antibiotics for two weeks. So of course, if I’m going in for surgery — ANY surgery — to give myself the best possible chance to avoid infection, I can’t be on Remicade.
Surgeries all the way down
In this case, my doctor was referring to “the surgery.” “The surgery” is actually a set of procedures that tends to captivate the popular imagination about trans people, especially trans women. Everybody wants to know what trans people are doing to their bodies. There’s facial feminization, breast augmentation (or mastectomy, for trans men), butt lifting…it’s surgeries all the way down, if you ask most people.
But being transgender is actually not all about the surgeries. It didn’t matter that I told him that surgeries weren’t in my near future, and possibly not at all. I had been taking hormone treatments for only 4 months at that point, and I explained that not all trans people elect to have surgeries, and even if I wanted to, I was at least 2–3 years away from doing them, given all the various therapists, psychologists, PhDs, and MDs that would need to recommend and approve me for them first (a set of hoops that cisgender people don’t typically have to jump through for the exact same procedures).
He kept saying, “you can think I’m the bad guy or some bigot, but you don’t know anything about me. You don’t know anything about me! I treated “transsexuals” in New York in the early 90s, and they were all addicted to drugs, sexually exploiting themselves, and infected with AIDS.” He finished, adding, “I think I have PTSD from that.”
I asked him, point-blank, “Are you uncomfortable treating me because I’m transgender?” He replied, “Yes.” He refused to allow me to continue on Remicade, despite the fact that nothing else about my health status had changed. He even went so far as to question whether I even have psoriatic arthritis, because he had never seen me present with any symptoms.
That was one of my favorite bits, actually. He was the one who had diagnosed me with psoriatic arthritis, more than ten years earlier! His transphobia blinded him even to his own credibility and expertise as a physician.
I explained again that I was not having any surgeries in the near future. I reassured him that with 6 years of experience on Remicade, I know that I can’t keep doing infusions if I’m sick or having surgery. He didn’t care. He prescribed a self-administered drug, Enbrel, which would be “more convenient” for me and so that “you don’t have to come in here as often.” He was so transphobic, he didn’t even want me to be in his office.
The year of living painfully
I took the prescription, and never set foot in his office again. Enbrel was largely ineffective for me — then Methotrexate, then Stelara — and over 11 months in 2018, when I had established care with a new rheumatologist (again), I tried to convince that rheumatologist to put me back on Remicade; it was difficult to convince him because there are potential complications with stopping & starting. As such, my condition declined rapidly and I spent most of the year spiraling toward disability, sometimes barely able to walk while I waited to be put on an effective treatment. I suffered in agonizing pain until late December, when I was finally able to restart the treatment that I never should have had to stop in the first place.
A year of pointless, preventable pain, just because I’m transgender, and because of transphobia.
The Affordable Care Act language protecting gender identity was still fully in place when I had my discrimination experience. But my doctor brazenly discriminated against me anyway.
More transgender people will die
This plan by the Department of Health and Human Services to remove healthcare protections for trans people will be death sentences for trans women of color and trans men, in particular, as rights and bodily autonomy are taken from people with uteruses in states like Alabama, Georgia, and Indiana. Over 40% of transgender people already attempt suicide due to lack of acceptance and affirming social structures. Trans women of color are murdered at an extraordinarily high rate compared to white trans & non-binary people. Four trans women of color were murdered just THIS WEEK in the U.S. Add to that the legalized refusal of necessary healthcare and trans bodies will begin to pile up quickly.
If health care protections are officially taken from transgender patients, it won’t even take knives or guns or fists or rape to kill us. It will just take a blank, unsigned prescription pad, or dismissal based on religious belief. It will just take a doctor who simply doesn’t want to treat transgender people, for whatever reason, whether the treatment is related to being transgender or not.
Maybe you aren’t a doctor, but you are someone who doesn’t believe trans people are real. Maybe you think it’s a lifestyle choice, too, or a mental illness. Maybe you even think it’s a sin against God and the natural order of things.
But if you are willing to take that belief all the way down to watching human life suffer and die not only under the pain of preventable, treatable, physical conditions but also under the emotional and spiritual brutality of ridicule, mockery, and the sick pleasure that transphobes take in refusing necessary care to trans people, then Trump doesn’t need to bother taking away trans people’s rights to kill us.
You’re already doing his dirty work for him.