Reproductive Justice Means Autonomy Over My Trans Body
by Silen Wellington (they/he)
I t was 2017. Shivering in the brisk Colorado spring, I lingered outside the glass doors of the health care clinic, clutching a printed letter in my hand as it crumpled in the breeze.
“Desire to be less feminine . . . a 21-year-old biological female . . . androgynous identity . . . significant mind/body conflict . . . genderqueer, nonbinary, demiboy . . . psychologically ready to proceed with hormone therapy,” the letter read, stamped with the address of my therapist’s office.
This is the letter that would allow me to get a prescription for testosterone.
I was tired of being misgendered, tired of avoiding singing, tired of the gravity of my menstrual cycle. I wanted my gender dysphoria to lessen, I wanted to feel less incongruence between my body and my identity, and I wanted to feel that gritty undercurrent of anxiety and nausea go away.
Even with this conviction though, I was nervous. I didn’t know I was trans until I was 19, and I didn’t want to look like a cisgender man. Would my doctor understand? Would they still write me a prescription?
With my heart leaping out of my chest, I entered the clinic.
Reproductive justice, a term coined by a term coined by the Black women who started SisterSong, means bodily autonomy, which includes having access to reproductive health care, like contraception, abortion, HIV care, pregnancy care, and more. It also includes trans-related health care, like getting access to the hormones we need with contraceptive options that will work for us and our bodies. Far too often, trans people face scrutiny and barriers to getting the health care they need.
I was among the lucky ones — I was able to access T (testosterone) fairly easily and had the medical insurance and financial resources to pay for it, which came out to less than $50 a month for my appointments and testosterone. This story would be very different without insurance, or if I was uncomfortable with needles and had to access any other type of T besides intramuscular needle injections (the most common type of T in the US). I have many friends who have had to go off T or delayed pursuing it because of needle-phobias, since other forms of testosterone (topical or patches) are often not covered by insurance. Some of my friends were quoted $600 a month to pay for non-injectable T and have resigned themselves to not pursuing the care they need.
Though I was terrified for my doctor’s visit, I could be honest about the nonbinary aspects of my gender experience, and advocate for the dose of T that I thought would be best for me. This ability to self-advocate has not always been the case when it comes to trans-related health care, especially for Black people, Indigenous people, and other People of Color who are disproportionately silenced and discriminated against in health care.
For decades, trans people seeking any form of medical transition in the United States had to conform to a very specific narrative and patients had to jump through medical hoops to receive the care they needed. Before pursuing transition, trans folks had to say they were “trapped in the wrong body,” and that they identified as heterosexual, or run the risk of being denied care. Many had to undergo a “Real Life Test” to prove they could live as the “other gender” and be economically productive before pursuing medical transition.
Today, trans adults in the US don’t usually have to conform to this binary, heteronormative narrative to receive hormone treatment/therapy, but seeking other forms of medical transition beyond this can often be difficult and unaffordable. Trans people have faced resistance, dismissal, and even outright refusal from doctors when pursuing a hysterectomy, because they were “understood as still being of reproductive age.”
According to One Colorado’s 2018 survey, in Colorado, 34% of respondents reported being denied LGBTQ+ medical services, like HIV medications, hormones, HPV vaccines, and other gender-affirming care. Only 52% of respondents reported having an LGBTQ+ competent primary health care provider, with LGBTQ+ competent care defined as care that “addresses the unique experiences of LGBTQ people and implements practices that affirm and respect them.” Trans Coloradans are 3 times more likely to delay health care because of cost than their cisgender peers, with 23% of trans respondents reporting having to pay more than $20,000 out-of-pocket for trans-related health care.
When we are denied health care, when our providers are ignorant or overtly discriminatory, when the cost to get our health care is exorbitantly high, pieces of our bodily autonomy get taken away. Reproductive justice must include advocating for trans-related health care, so we can have access to reproductive care without unnecessary gatekeeping and without providers scrutinizing or dictating our decisions. Reproductive justice means autonomy over my trans body.
