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Last month, the Supreme Court ruled that LGBTQ+ people could not be discriminated against when it comes to employment.
But three days before that, the Trump administration rolled back protections for transgender people when it comes to health care.
While those protections guaranteed someone could see a doctor, they didn’t stop many of the barriers to health care that transgender people face every day. The protections didn’t guarantee insurance coverage or prevent other forms of discrimination.
Obama era protections for the transgender community included requiring Medicaid, Medicare and health care plans on the marketplace to cover transgender individuals.
Many of those plans didn’t cover, and still don’t cover, gender affirming care, such as chest reconstruction surgery and hormone replacement therapy.
The federal protections also don’t require doctors to have experience treating trans patients, or prevent them from using the wrong pronouns and names.
“A lot of the transgender community is discriminated [against] already by doctors, doctors’ offices,” said Denise Johnson said, founder and CEO of Florida Trans Proud. “And if we’re not discriminated against, we’re not finding doctors and medical staff who are experienced.”
Though Johnson said keeping some doctors from being insensitive may be difficult to legislate, she worries the new language from the Trump administration will make the situation worse. It could start a slippery slope that leads to even more misgendering and bigotry against transgender patients.
“He’s just giving them more and more license to harm us,” Johnson said.
METRO Inclusive Health in St. Petersburg offers primary care with an LGBTQ+ focus, with 1,100 patients coming in for hormone replacement therapy alone.
Lucas Wehle, the Trans Services Division Manager, said the protection rollback is “a major step in the wrong direction.”
And he’s not alone.
“It starts with a small portion of the trans health care, and then it later progresses to other areas of our community, where they’re slowly taking away rights,” said Kiala Emmons, a service navigator at METRO who helps direct patients toward the services they need, or refers them to partner specialists and surgeons.
She said discrimination can cause trans people not to seek care at all. Discrimination includes doctors refusing to use the correct pronouns or referring to a patient by their birth name, often referred to as a “dead name” in the trans community.
“Discrimination can create very traumatic experiences and I am very fearful of what the future holds,” Emmons said.
That trauma — more than cost — is what causes some transgender people to use black market hormones or forgo seeing specialists for things like heart care or dermatology like any cisgender person, Emmons said.
“They aren’t self medicating most times because of the cost,” Emmons said. “It’s the level of comfort that we receive when we go into these health care facilities.”
So if legislation is important, but can’t prevent discrimination, what’s the key?
“We need to educate the medical services and of course, the large medical organizations that govern doctors,” Johnson said. “They are on board and they’re advocating for doctors to become educated. Gosh, that’s just the big thing. Education all the way around, in my opinion, both in society both within the caregivers of society.”
Johnson said she doesn’t necessarily need her doctor to understand what it means to be transgender, or to even agree with it, but said: “If you’re in the medical profession, did you not take an oath to do no harm, and to treat your patients and let your personal biases take a backseat?”
Dr. Deborah DeWaay works with medical students at the University of South Florida Morsani College of Medicine.
She said two years ago, medical students there started “unconscious bias” training that addresses that backseat issue.
Students can also do independent and guided research into subjects like hormone therapy or gender bias.
“We have a lot of ways that students can personalize their own education,” DeWaay said.
Scholarly concentrations include healthcare disparities, public health, biomedical research – it runs the gamut.
“The great part about how it’s structured is that if a student, for example, has an interest in learning more or becoming more of an expert in transgender medicine, there’s a whole plethora of ways that they could do that.”
But most medical schools don’t offer mandated training for all future medical providers, or specific training beyond the occasional transgender seminar, and there’s no certification that makes someone a transgender medical expert.
However, DeWaay said, medical students are coming to the school and they’re expecting to be educated on transgender health.
“I have these really wonderful medical students who have really, really big hearts and who see the world differently,” DeWaay said.
“I think that they’re demanding changes. I think there are those of us who are older who have wanted things to change for a while and haven’t known how to do it.”
Lucas Whehle from METRO said USF students went from one day to two days of LGBTQ+ training, which includes a panel METRO is involved with that allows students to meet and ask questions of transgender people.
“But keep in mind, this is two days out of however many years they’re in school for becoming a doctor. And that, to me, is very concerning. But they’re doing something right now, other people aren’t really getting that education. And then if you’re talking about people who’ve already been practicing decades, they don’t have requirements.”
Kiala Emmons, at Metro Inclusive Health, said that’s why it’s important for medical professionals to take it upon themselves to learn more – and do better.
“You may have to educate yourself if it wasn’t included in the curriculum,” Emmons said. “I think that when a medical provider is passionate about the work that they do, they will take time to further their education when it comes to any particular community.”
She said that it’s particularly important for transgender people to be their own patient advocates for care, and to reach out to organizations like METRO or Florida Trans Proud that keep lists of trans-friendly medical providers.
Emmons emphasized that it’s ok if not every doctor treats trans patients. She’d rather go to someone who wants to help, not someone who is forced by the government to give her subpar care.
“Those providers that don’t feel comfortable treating our trans clients, I think that’s not a problem for me. I just hope they’re not discriminatory when they’re doing it,” she said. “Because if, if you’re trying to get a breast augmentation, and this surgeon only works on feet, he’s going to refer you somewhere else.”
“So if you’re not capable, or if you’re not competent in working with trans clients, it’s okay to send them somewhere else that does, but when you do send them somewhere, make sure you have the language to send them to the proper place so that they’re not leaving your offices feeling upset in or traumatized.”
Emmons added that it’s also important for trans people to pursue careers in health care so they can see providers who truly understand the trans experience. She’s already going back to school to be a mental health therapist.