Transgender patients face fear and stigma
in the doctor's office
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[September 15, 2016]
By Daniel Trotta
NEW YORK (Reuters) - Tanya Walker had lung
cancer and was coughing up blood, but she says her emergency room doctor
kept asking about her genitals.
"It seemed like they weren't going to treat me unless I told them what
genitals I had," Walker, a 53-year-old transgender woman, activist and
advocate, said about her 2013 experience in a U.S. Department of
Veterans Affairs hospital in New York. "I felt cornered."
She experienced a stigma shared by many transgender people. The same
rejection they confront at home and in society can often await them in
the doctor's office, where many report being harassed, ridiculed or even
assaulted.
Transgender issues have soared into the U.S. public consciousness since
the U.S. Supreme Court ruled last year that same-sex marriage was a
constitutional right. With that final item on the gay and lesbian agenda
fulfilled, gender minorities turned their attention to unrealized
transgender civil rights.
Society is gradually learning the basics of gender identity, but the
medical profession has been slow to adapt, according to leaders in
transgender medicine, transgender advocates and patients.
About 30 percent of transgender patients report delaying or not seeking
care due to discrimination, according to a report published in the June
edition of the journal Medical Care. One in four say they were denied
equal treatment in healthcare settings.
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Walker said the doctor who was distracted by her sex organs misdiagnosed
her lung ailment as tuberculosis. He gave her antibiotics and sent her
home. Three months later she discovered she had lung cancer, Walker
said, though she is now cancer-free.
Some doctors acknowledge their profession is woefully out of date.
"We have a lot to apologize for in the medical community. Our treatment
of transgender people has been abhorrent," said Dr. Aron Janssen,
founder and director of the gender and sexuality service at New York
University Langone Medical Center.
"The medical world is very far behind. It is a conservative
organization. Things are slow to move," said Janssen, who only takes new
patients who are transgender.
Transgender people, who by a UCLA Williams Institute estimate account
for 0.6 percent of the population, or 1.4 million Americans, face acute
medical needs. They have higher rates of preventable disease, substance
abuse, suicide attempts and mental health issues than the general
population.
Transgender patients whose healthcare providers were uneducated on
transgender issues were four times more likely to delay needed care,
according to the June report in Medical Care by Kim Jaffee and Deirdre
Shires of Detroit's Wayne State University and Daphna Stroumsa of
Detroit's Henry Ford Hospital.
Simply by asking questions, doctors who lack knowledge on transgender
issues "can unwittingly create an atmosphere of disapproval for
transgender patients," their research found.
Transgender patients say they are routinely "misgendered" and referred
to by their birth names and gender, even if their identity documents
have been legally changed.
Jay Kallio, 61, a transgender man, had a lump in his breast checked out
in 2008. He said his main doctor, who he declined to identify, never
called back with the results of a biopsy and he only discovered he had
aggressive breast cancer when a radiologist happened to check up on him
weeks later.
![](http://archives.lincolndailynews.com/2016/Sep/15/images/ads/current/Bonanza_sda_072214.png)
Kallio did eventually speak to the primary doctor.
"He immediately said, 'I have a problem with your transgender status.'
He said, 'I don't even know what to call you,'" Kallio said.
POCKETS OF PROGRESS
The picture is not universally grim for transgender patients, who say
medical professionals have become more adept in recent years, especially
at large medical centers in big cities.
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![](../images/091516pics/news_b3.jpg)
Tanya Walker, a 53-year-old transgender woman, activist and
advocate, gives an interview at her apartment in New York City, U.S.
September 7, 2016. Picture taken September 7, 2016. REUTERS/Brendan
McDermid
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New York's Mount Sinai Health System culturally trains all employees at
its seven hospitals who have any contact with transgender patients and
in March opened the Center for Transgender Medicine and Surgery,
offering integrated care.
"Compared to where we were when I started trans work in the early
'90s, we have made tremendous progress," said Dr. Barbara Warren,
director for LGBT programs and policies for Mount Sinai.
Even so, nearly 42 percent of transgender men reported verbal
harassment, physical assault or denial of equal treatment in a
doctor's office or hospital, according to a separate report issued
last year by Shires and Jaffee.
Their research was a secondary analysis of a 2011 survey by the
National Center for Transgender Equality and the National Gay and
Lesbian Task Force. That survey of 6,450 transgender and gender
non-conforming people found 19 percent were refused medical care and
2 percent said they were victims of violence in a doctor's office.
The U.S. Department of Veterans Affairs has since 2014 offered
specialized transgender training for its medical staff, including an
online course taken by 4,800 employees, a seven-month training
course, and a service that makes transgender health experts
available to providers for consultations.
"I'm very proud of what we have been able to achieve and compared to
the civilian world," said Jillian Shipherd, the Veterans Health
Administration official who oversees training on transgender health.
Shipherd said she could not comment on Walker's case for privacy
reasons, but did say, "I am very sorry to hear that was Tanya's
experience."
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Most medical schools are failing to prepare their students,
according to a 2011 study published in the Journal of the American
Medical Association. The median time dedicated to teaching
LGBT-related content was five hours, and experts say most of that is
for gay and lesbian issues, bypassing transgender health completely.
The Vanderbilt University School of Medicine in Nashville,
Tennessee, is an exception, requiring three courses on LGBT health
in its curriculum.
The medical center, which treats about 250 transgender patients, has
created the Transbuddy Patient Navigator program that assigns every
transgender patient a helper to navigate the healthcare system. The
hospital also has a 24-hour transgender hotline.
"It takes a lot to get through the stress of coming out as a
transgender person. There are tremendous behavioral health needs,"
said Dr. Jesse Ehrenfeld, director of LGBT health at the center and
a professor at the medical school.
Private insurers are also at the vanguard, changing record-keeping
systems so that, for example, a transgender man who has legally
changed his identity documents but is still capable of getting
pregnant will not be denied obstetrics and gynecology care.
"Right now we have three transgender men who are pregnant and they
are going through ob-gyn care," said Mount Sinai's Warren. "They're
all insured by companies that completely understand. ... It's a work
in progress."
(Reporting by Daniel Trotta; Editing by Dina Kyriakidou and Stuart
Grudgings)
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