“Are you sure you don’t need a pregnancy test?”
“I swear I don’t. I’ve been on testosterone for the past year, and I’ve only been having sex with people with vaginas.”
There’s bemused frustration in UC Berkeley junior Benji Delgadillo’s voice as they recount their interaction with their primary care doctor. A mason jar filled with the empty syringes of testosterone shots with needles removed and old acrylic nails pooling at the bottom sits in their room. It used to be their condom jar. Now it’s a testament to change.
“(The syringes) represent how, at one point in my life, I needed to be recognized and legitimized by science and the medical community and also my own agency in being able to modify my body the way I want to. People think you can’t change what you look like.”
Benji is living proof that you can. Sporting a black beard and mustache, dramatic pink eyeshadow expertly drawn and a buxom chest, they bend gender and sex by existing in the unexplored spaces between woman and man, female and male.
The latest version of the Diagnostic and Statistical Manual of Mental Disorders, now in its fifth iteration, has an entry for gender dysphoria as a diagnosis, correcting the term “gender identity disorder,” which explicitly deemed such individuals in a state of “disorder.” The entry for gender dysphoria carries two paradoxical meanings for the transgender community: continued access to care under the present health care system, because an official diagnosis is the prerequisite for services, as well as the continued pathologization of their identities. This becomes apparent when a particular medical visit has nothing to do with a person’s transgender identity.
“Even though I tell them, ‘No, no, I’m here because I have anxiety. I’m fine with my body,’ they’re still going to pathologize you, whether it’s your primary care doctor, mental health provider or other medical practitioner,” Delgadillo said. “They assume that trans people have serious delusions about their bodies.”
The problem is manifold. Our health care system caters to cisgendered, heterosexual people and makes it difficult for others to access services, providers and insurance carriers that are understanding and respectful of their needs. Health care practitioners alienate and pathologize LGBTQ folks with misreadings and outright refusals to acknowledge people’s self-defined gender identities and/or sexual orientations. Insurance carriers discriminate against LGBTQ folks by denying necessary services based on exclusions or faulty criteria.
One of my friends, who identifies as a lesbian, has a doctor who asks at every appointment if she has a boyfriend. No, she doesn’t and never plans to. Assumptions about whom LGBTQ people have sex with and what kind of sex they’re having abound.
When Benji told their urgent care doctor they were only having sex with people with vaginas, the doctor said, “So you’re just having oral sex.”
Actually, people with vaginas do not only have oral sex with one another.
These assumptions, which appear fairly innocuous on their own, represent the tip of the iceberg when it comes to the health care system’s massive inequalities. What’s at stake is not hurt feelings. What’s at stake is health care that does what it’s purported to do: provide care to ensure good health.
Insurance carriers and doctors routinely deny treatment and/or coverage for transgender people. Some plans state they do not cover any transition-related services and then deny coverage for transition-unrelated medical visits such as the flu or a broken arm simply because the person claiming the services is transgender.
Having to choose between identifying as male or female means transgender people are sometimes forced to select which parts of their bodies they want to receive care for. For example, testosterone might be covered if a person transitioning from female to male checks the male box, as testosterone is prescribed for hypogonadism. But, by doing so, he would forego coverage for necessary ob-gyn services. The reverse would be true if he checked the female box.
The good news is that change is happening. According to Benji, UC Berkeley serves as a model for other UC campuses with its inclusive health services. The Tang Center has a trans care team that includes a transgender health specialist. This past year, SHIP lifted caps on medical benefits for all students, including lifetime and pharmacy limits.
Furthermore, the country has seen changes worth celebrating this LGBT Pride month: from the end of a ban that prevented Medicare from covering sex reassignment surgery — or the more positive term, sex affirmation surgery — to the lifting of a ban on transition-related coverage for federal employees. But we still have a long, long way to go before everyone has meaningful access to healthcare, regardless of gender identity or sexuality.
Most importantly, we don’t need to be members of excluded communities to be sensitive to the ways in which health care is blatantly noninclusive. Anyone can and should be an ally to those left out of the system by engaging, self-educating and advocating quality, affordable health care for all.
Even though I’ll be cheering as loud as the next person at SF Pride this weekend, I won’t be able to help wondering, “What do we have left to work on to achieve equality?” This is still only the beginning.