The lead author of The New York Academy of Medicine’s “Transgender: Speaking Out for Better Care” report, part of the Academy’s City Voices on Health series, talks about barriers to quality health care for transgender New Yorkers.
I grew up in Thailand. To most tourists, it’s a magical place with gorgeous beaches, a beautiful culture, and amazing food. Yet, to many transgender (trans) people, Thailand has long been a place for another kind of journey. Since the late 1990s, it’s been a mecca for sexual reassignment surgery. As a young man, I recall wondering why trans men and women from a developed country like the United States had to travel across the world to Asia for health care. As a cis-gendered man (a person whose biological gender matches his gender identity), I had no idea what was behind the trend.
Years later, after becoming a public health professional in America, I became interested in trans health access issues (e.g., counseling, hormone therapy, surgery) affecting United States veterans. That’s when I learned about the difficulties—lack of coverage, discrimination, provider ignorance—that trans men and women, many of whom had risked their lives for their country, faced when attempting to embrace their gender identity in the U.S.
Despite Thailand’s somewhat conservative stance on LGBT rights (there’s no same-sex marriage or LGBT anti-discrimination laws there), the country’s medical professionals offered trans persons decades of experience in sexual reassignment surgery and more welcoming and knowledgeable providers, at roughly one-quarter the cost of having the procedure in the U.S.
The experience led me to think more about the trans community in my new home, New York City (NYC). My ultimate goal as a public health professional is to ensure that everyone has the best chance for optimal health, but before I could think about what to do to improve trans health, I needed to understand what was really going on. That opportunity arose in the summer of 2014 when I began work on a unique Community Needs Assessment (CNA), including onefocused on transgender health in NYC.
The CNA produced a collection of personal narratives from trans men and women, as well as health and social services providers for the LGBT community, published this month in the report "Transgender: Speaking Out for Better Health," part of the Academy’s new City Voices New Yorkers on Health series. Through the CNA, I quickly learned that even simple things that most of us take for granted were barriers to health care if you were trans.
What’s in a Name?
One health expert told me, when you conduct the CNA, be sure to ask about the name issue. I was a little puzzled. How does being John or Jane have anything to do with care? A lot, it seems. One CNA participant explained that some insurance companies required a female (or male) name matched to an ID marked female (or male) to reimburse a person for estrogen (or testosterone) therapy. “They shouldn’t make people change their name,” she said with frustration. “You should be able to live your life the way you want to live...That’s your life.”
Overall, our CNA found that while there is progress, an unreceptive health care environment, a lack of knowledge about trans health issues, denial coverage for transition-related care, and a shortage of trusted providers still keep many trans New Yorkers from needed health care.
I see “Transgender: Speaking Out for Better Care,” as a chance for those of us who are not transgender to understand how to ensure that everyone in this great city can be healthy, no matter who they choose to be along the fluid gender identity spectrum.
It’s an opportunity for policymakers, health care providers, and community organizations to learn what transgender New Yorkers really want and need when it comes to their health and well-being.
Many changes have been made toward advancing transgender health this year, including New York State lifting the ban on Medicaid reimbursement for trans health services. I also hope to be a part of that change by learning as much as I can about the trans community and trans health.
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