Rylee Jackson doesn’t go to the hospital. At least, not until a trip to the emergency room seems inevitable.
“It’s scary,” she says. “It’s scary enough knowing that you’re going to have to disclose.”
In 2015, Jackson experienced severe and prolonged abdominal pain, but she avoided seeking medical attention. She says she was afraid that medical professionals might harass or assault her, or that pervasive transphobia might affect the quality of care she received. That fear is common among transgender people, and not without cause.
In 2015, 33% of trans and gender nonconforming people in the U.S. reported having had “at least one negative experience,” in a healthcare setting—including verbal harassment. Like Jackson, nearly a quarter of all transgender people avoid healthcare settings out of fear.
Jackson says she didn’t seek medical attention until the pain was unbearable: “I was literally bleeding in my bathtub before I went to the hospital.”
When Jackson’s boyfriend finally drove her to the emergency room at Mercy Medical Center in Canton, she was admitted immediately. A doctor told her that she had a stomach ulcer and would need to undergo emergency surgery. Throughout their interaction, the doctor and other emergency room staff intentionally and persistently misgendered Jackson.
After repeated requests, the doctor only doubled down. “He said, ‘I’m calling you the pronouns you were assigned at birth.’ But my name and gender marker were already changed. I was just really upset by that,” Jackson says. “It was already really bad.”
For transgender people, dealing with unfamilar healthcare professionals can be dangerous— even deadly. At worst, a healthcare professional could intentionally harm Jackson, or refuse to treat her entirely.
According to the most recent National Transgender Discrimination Survey, 2% of all trans and gender nonconforming people report having been physically or sexually assaulted in a healthcare setting. A 2011 survey found that for people who are both transgender and Black, the likelihood of experiencing a physical assault in a doctor’s office, hosptial or emergency room more than triples.
Further, according to the same survey, 23% of trans and gender nonconforming people who come out to healthcare professionals are denied care entirely— a number that LGBTQ+ advocates expect to increase as a result of recent federal rollbacks in nondiscrimintory protections for trans and gender nonconforming people.
In 2019, the Department of Health and Human Services announced a plan to change an Obama-era ruling that protected trans and gender nonconforming people from discrimination in healthcare by classifying discrimation based on a person’s gender idenity as a type of sex-based discrimination.
The Trump administration’s final interpretation of the rule states that trans and gender nonconforming people are not protected from such discrimination. Human rights advocates and LGBTQ+ activists say this change could allow healthcare providers to deny care to trans and gender nonconforming patients with few legal repercussions.
Samuel Hoskins, an Akron-based transgender rights activist, calls the rollback in protections for transgender people unconscionable.
“It’s just a blatant, willful misunderstanding of what we’re going through and what we have to deal with on a daily basis to function,” Hoskins says. “It’s ignorant, and it’s willfully ignorant.”
For trans people, it can be difficult to find healthcare professionals who are trained, knowledgeable and affirming of transgender and gender nonconforming patients. And in the event of a medical emergency like Jackson’s, it can be even more difficult for trans and gender nonconforming people to protect themselves.
“There’s always a level of general education that [trans people] have to do,” explains Hoskins.
And even when healthcare professionals are affirming of trans patients, there’s often a steep learning curve.
“An exorbitant number of trans people avoid going to the doctor for preventative care because they don’t want to have to educate people, and they don’t want to have to deal with very thinly veiled bigotry,” Hoskins says. “Trying to take care of yourself as a trans person is exhausting, and made no less exhausting by things going on in the world right now.”
Hoskins is currently seeking treatment for an ongoing cardiological issue — a condition he says he’s been dealing with for years. But when he ended up in the emergency room earlier this year after experiencing signs of a heart attack, Hoskins’ doctors dismissed his symptoms. Over and over, medical professionals told Hoskins his symptoms must be related to his hormone intake. He had been experiencing those symptoms for 5 years, but had only been taking hormones for about 18 months.
“In a perfect world, it would make no difference. Because being trans has nothing to do with the fact that you have a sinus infection, or that you rolled your ankle,” says Dr. Scott Hamler. “But when you’re registering, the name on your driver’s license [might] not be your preferred name, or the name on your health insurance isn’t your preferred name. And then you’re going to be outed. And I think there’s this fear that that will impact and affect the care that you receive.”
Hamler, who practices family medicine at Summa Health Pride Clinic at Chapel Hill Medical Center, says there’s no doubt that the discrimination, harassment and violence that often occur within healthcare systems have devastating and long-term effects for transgender people. The Summa Health Pride Clinic opened in September 2019 and has actively worked to remove common barriers to care for trans and gender nonconforming people.
“There’s long-term detriment to not having that safe, comfortable, welcoming home where you can go in for your preventive care,” Hamler says. “The goal is, at the Pride Clinic, that the patients are able to set up a comfortable medical home for themselves without fear or judgment. That’s what we’re trying to set up with the Pride Clinic,” Hamler adds, “and then sort of use that as a model for healthcare in general.”
From his home office, Hamler explains that he and his husband have experienced barriers to healthcare firsthand.
“I’m a member of the [LGBTQ+] community,” says Hamler, “so I’m well aware of the obstacles and barriers [trans people face]. There’s disparity, this gap, this void that needs to be filled,” he says. “There are people who aren’t getting healthcare.”
“I can masquerade as a straight, cis guy and I’m not outing myself every time I go to the doctor,” Hamler explains. “If I’m going to my doctor for a cold or sinus thing or a rash, being gay has absolutely nothing to do with that medical condition. But for somebody who is trans,” Hamler says, “that is significant. Because you’re kind of having to out yourself every time you go to access medical care.”
Even picking up prescriptions can expose transgender women like Jackson to targeted violence and harassment.
When a transgender person’s legal name and gender marker don’t align with their identity, they are outed not only to the pharmacist assisting them, but to bystanders as well—a situation that has been particularly distressing for Jackson.
At 27, Jackson says she’s been experiencing gender dysphoria more frequently and intensely than she did in her early 20s, which can make navigating public spaces overwhelming. For transgender people, being deadnamed or misgendered can be devastating, and might make them more vulnerable to harassment and assault.
“All eyes are on you, and [people] are looking you up and down,” Jackson says. “I just think there needs to be some type of rules or guidelines in place.”
When doctors offices and pharmacies do enact protocols, or when healthcare professionals receive training that enumerates the specific risks and barriers trans and gender nonconforming patients face, instances of targeted harassment and discrimation can be significantly reduced.
Hoskins and Jackson both see Dr. Hamler as their primary care physician at the Summa Health Pride Clinic. They say Hamler and the Pride Clinic have changed the way they think about healthcare, and the way they interact with healthcare professionals.
“He feels like a friend,” says Jackson. “There’s something about the way he talks to you that you feel it. This isn’t a burden for him. He really wants to help.”
When Jackson underwent surgery at Mercy Medical Center in 2014, she knew she’d need a followup operation. After such a traumatizing experience, Jackson decided to undergo a second operation at Summa Health.
After she was admitted, Jackson says she noticed the gender marker on her wristband was incorrect. When she told the nurses that there had been a mistake, they apologized profusely and corrected the gender marker immediately.
“They seemed genuinely sorry,” Jackson says. “They said ‘We’ll get that changed right now. We don’t want you to feel uncomfortable at all.’”
“It blows my mind that it took us so long to start filling this gap,” adds Hamler. “With the prevalence of depression and anxiety and suicidality and suicidal attempts, and all these disparities that exist — if any other segment of the population had those disparities, it would’ve been like public enemy number one.”
Almost half of all transgender people attempt suicide in their lifetimes, nearly 10 times the rate in the general population.
“Now that we’re actually fixing that and trying to fill those voids, and fill the gap, we’re getting more research,” Hamler adds. “And the research is obviously supporting the fact that society has done this to us.”
Jackson hopes that speaking publicly about her experiences will pave the way for a more inclusive and affirming healthcare system.
“I would never have thought that I would be in this position to be an advocate,” Jackson says. “But I didn’t have these types of tools when I was young. If I could help pave the way for the next generation of trans, queer, non-binary people, to make life easier, I feel like I have had a purpose on this earth.”
In the lobby of the Summa Pride Clinic, Pride flags let patients know where they are. Admissions staff have all received LGBTQ+ sensitivity training, so a new patient will never have to worry that their deadname — the name assigned to them at birth — is still on their ID. Here, says Hamler, trans and gender nonconforming people can relax.
“The goal is, and the reason I’m there as a primary care doctor, is that this should be a comfortable medical home for you. You come in and you see familiar faces. You know you’re safe there physically. You know you’re safe there emotionally,” Hamler says. “If you’re waiting in the lobby with somebody else, you don’t have to worry about getting that kind of side eye, and just that sort of judgmental look.”
Jackson, who spoke on a Summa Health panel announcing the creation of the Pride Clinic, says Hamler’s office is everything she envisioned. “It makes you feel at home,” she says. “It makes you feel like, ‘Okay, I can open up. They’re people like me.’”
Hamler and the Pride Clinic have laid blueprints for a more inclusive and accessible healthcare experience for transgender and gender nonconforming people—a process that Hamler says can be duplicated anywhere in the country. That in itself, Hamler says, is a mark of great progress.
“I’ve been practicing for almost 15 years at this point, and for me, it’s really rewarding,” says Hamler. “Patients are coming in and they haven’t had care for so long—they’re just so relieved. You can read it on their faces.”
For Hoskins, Hamler and Jackson, that relief is part of a much bigger picture. When trans and gender nonconforming people are able to access comprehensive, compassionate and affirming healthcare, they’re better able to live long, healthy and joyful lives. And while that may not be the current reality for trans and gender nonconforming people in America, it’s a future that Hoskins, Hamler and Jackson believe is possible.
“Most of us have had a lot of unhappy moments in our lives,” Hamler says. “In the course of my day, there’s a lot of ups and downs. We’ve got tears and we’ve got laughter, and everything in between. But generally, it’s joy.”
“There are people immediately around us that are kind and understanding and helpful,” Hoskins says. “You just have to know where to find them.”
H.L. Comeriato covers public health at The Devil Strip via Report for America. Reach them at HL@thedevilstrip.com.