Hormone Replacement Therapy is generally considered safe and effective for most transgender women, but no medical treatment is without risks. In this case, an increased potential for blood clots, which is faced not only by trans women, but by anyone undergoing bio-identical estrogen replacement. That risk increases for those who smoke, like I did for a good part of the past 7 years, including my first 7 months on estradiol, till I quit about five months ago. It’s the main reason self-treatment is so heavily discouraged. Although rare, there have been trans women who’ve even suffered sudden death while self-medicating. But the hormones themselves aren’t the issue, rather the lack of monitoring.
Everyone’s body is different, so it’s crucial to have a qualified endocrinologist to order labs and actively monitor everything from estrogen and androgen levels to potassium, and more. At least, that’s what they’d do if we lived in an ideal world, where anyone actually cared about trans women’s health.
Unfortunately, that’s not the world we live in.
When I finally got my approval to start HRT last year, after 12 long weeks of therapy, (which had surprisingly little to do with my gender identity, and much more to do with my BPD,) I couldn’t even schedule an appointment with the only endocrinologist in my city who treated trans women at the time, as the practice he worked for was excessively gatekeeping. That was a year ago, and he’s since left to open his own practice where he’s proving to be one of the area’s best options, and I’ve already arranged to start seeing him for my needs, but back then, it was a massive issue.
I was forced to look out of state, where I found a doctor who was willing to see me with just my letter, but his staff was also incredibly transphobic. They condescendingly refused time and time again to even call me by my preferred correct name or even make a note in the system about it. Instead they insisted on using that painful, meaningless collection of letters which only even still resides on my ID because I can’t afford to pay over $400 just to have a judge decide whether or not I actually deserve it. Don’t get me wrong, I understand that legal paperwork requires legal names, and I’ve never made a fuss about that, but that’s not what this is about. It’s about addressing people with the respect they deserve, and I know full well and good that no one would make a fuss if I’d asked them to call me by a masculine nickname, my middle name, anything but a feminine name.
They also refused to accept insurance for trans patients. Ironic considering that I actually had insurance at the time, from a trans friendly employer, which would have covered my treatments if they had. Of course, now they do, now that I’m uninsured, and on my last phone call, they finally asked for my preferred name, but it’s not because they care.
It’s just that now they have to accept insurance without regard to gender identity (Thanks Obama!), and thanks to repeated calls from local human rights advocacy groups I work with, they’re finally starting to think twice about dead-naming us anymore. They only do what they’re forced to do.
A responsible endocrinologist wouldn’t dream of letting a woman go a full year on estradiol without blood work to ensure her levels weren’t getting dangerously high.
That is, until she’s trans. For my former doctor’s office, it’s not even a simple oversight, it’s a flat-out refusal. They won’t write orders for it to be done in house, or anywhere else for that matter. Hard to shake the feeling that the chest pains I’ve now been experiencing for four days might not be an accident.
Of course, the possibility of malpractice is a very secondary concern at this point. My chest pains could be any number of things. It could be a clot in my lungs, or it could be really stubborn gas.
I’ll breathe easier once I know (pun intended), but who can I even see without having to worry about being turned away or ignored? I could even have my symptoms blamed on my gender identity in yet another case of so-called “trans broken arm syndrome,” a ridiculous sounding, but very real phenomenon, wherein healthcare providers like to pretend everything they learned in medical school suddenly went out the window the second a trans patient walked in their door.
Planned Parenthood seemed like the only viable option, at least until I called and they refused to schedule an appointment for me.
When I asked why, the only reason the receptionist could give me was that although some Planned Parenthood locations offer trans health care, it’s not currently available in the Southeast. I can’t say that I’m surprised, the “Bible Belt,” is well known for homophobia and transphobia, and if there was a buckle on that belt, it would be where I live. All the same, it leaves me caught between a rock and a hard place.
As a feminist who cares about the health of all women, and the reproductive rights of all uterus-owners, I’ve had a long history of supporting Planned Parenthood, but as a transgender woman who’s now left with no truly safe option to turn to for what I’m hoping is just some sort of digestive issue, but could potentially be life threatening, I’m really forced to reconsider that.
It’s one of many sad truths about life as a trans woman. No one cares about our health until they’re forced to.
Even then, it’s not as though they actually care, which is why even legislation only solves so much. Attitudes need to change, and I really hope they change soon.
For all I know, my life may one day depend on it.
Update: Delia was seen at an emergency room, diagnosed with pleurisy and is being treated. She thankfully did not appear to have blood clots or any other serious issues with regard to her chest pains.
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