The Fifth Annual Transgender Symposium :: Every Day A Struggle

Many discussions at the Fifth Annual Transgender Medical Symposium in Fort Lauderdale focused on the difficulties that transgender people face. These difficulties include body image, discrimination, and harassment.

Body image may present the most consistent challenge for trans people. Marilyn Volker (Sexologist) reported that some trans people buy male or female hormones from street dealers. Dr. Joanne Keatley (The Center for Excellence in Transgender Health) stressed that medical providers should accommodate their trans patient's need for hormones. This would get trans men and women off street hormones. Keatley felt that this could motivate trans people to stay in clinical trials.

Keatley reported that some transwomen seek street plastic surgery in order to "pass," or further express their gender identity. This street plastic surgery seeks to augment tissue in the breasts and buttocks with fillers. Pseudo-doctors set up pumping parties to provide pseudo-fillers. At these parties, they inject transwomen with industrial grade silicone, caulk, or even motor oil. Some people may die on site. Eventually these pseudo-fillers will shift to other areas of the body.

Keatley also reported problems with data collection. The emphasis on using electronic health records (EHRs) makes this more critical. These records follow the patient to different sites. Data entered in the EHRs prompts the provider to ask certain questions. The current standard input form, however, lacks a way to input trans data. Transwoman surgery leaves the prostate intact. If no one has input her trans status into the EHR, it will not prompt the provider about a prostate exam. Sites can request a form to collect transgender data for their site. That data will not travel with the patient to other sites. Transgender advocates are now lobbying to have transgender data on the standard input form of the EHRs.

In the Federal system, the Centers for Disease Control (CDC) has the software to collect transgender data. The CDC, however, made collecting trans data optional. It also failed to give guidance to the states on how to collect trans data.

Keatley reported that discussion about trans people focuses primarily on transwomen. As a result, transmen become invisible.

While data collection refers to group level data, medical care occurs at the individual level. Multiple speakers at the symposium emphasized asking at intake which pronouns the patient prefers. They also recommended noting this preference in the records.

Keatley emphasized that not all health problems of trans people involve trans issues. Health care providers should deal with the issues important to the patient, unless the patient requests a general checkup. Providers should access the health of the current body parts, but always respect patient's current gender identity.

Keatley discussed the report, Injustice at Every Turn. This report analyzed the responses to a survey of transgenders. About 50 percent of the respondents had to educate their providers about how to provide care. Another 19 percent reported that health providers had refused to provide care to them. In addition to providers refusing care, about 25 percent of respondents reported harassment or disrespect in their health provider's office.

Keatley reported that serious problems occur in sex segregated secured facilities such as prisons, jails, mental hospitals, and gender specific bathrooms. According to the report Injustice at Every Turn, among incarcerated transgenders, 37 percent reported harassment by staff, 35 percent reported harassment by other inmates, and 15 percent reported sexual assault. Almost all speakers reported problems with gender specific bathrooms.

Social "bads" do not affect all transgender people, equally. These social "bads" tend to cluster among low-income, low-education, African-American trans people.

For a much more detailed report on challenges that transgenders face read the report Injustice at Every Turn, please visit http://bit.ly/1eCwFYv