Transgender Georgians face myriad of healthcare challenges

Transgender Georgians face discrimination when accessing healthcare, are denied care over their gender identity and sometimes don't seek medical care over concerns about being mistreated, according to a new report detailing the problems and offering ways to address them.

The report – Voices for Equity – is a collaborative effort between Georgians for a Healthy Future, the Health Initiative and Georgia Equality. It compiles data from a survey and four focus groups the organization conducted last year, as well as data from the 2015 U.S. Transgender Survey.

Some 60 percent of transgender survey respondents experienced discrimination in a healthcare setting due to their gender identity, according to the report. It also found that one in three transgender Georgians have been denied healthcare in the past year due to their gender identity, and one quarter of transgender survey respondents did not see a doctor when they needed to over concerns that they would be mistreated.

The groups released the report and hosted a panel discussion about it during a public forum at the Rush Center on Sept. 13.

“A lot of transgender Georgians are, when they seek healthcare they are getting medically and culturally incompetent care,” said Laura Colbert, a cisgender woman and executive director at Georgians for a Healthy Future.

“So they are seeing doctors who are pushing their religious view, who are questioning their need to transition, who are, you know, referring to them by the wrong pronoun or their legal name rather than their preferred name,” Colbert added.

Transgender people face multiple barriers to getting both trans-specific and non-gender related healthcare. They are more likely to be uninsured than non-trans people, and even with insurance, transgender people struggle to find doctors that can provide both medically and culturally competent care.

“I was self medicating hormone therapy, which is hazardous, and I was in search of an endocrinologist,” Chloe Jordan, a transgender woman who works on transgender inclusion in clinical trials at Emory’s Hope Clinic, said during the panel discussion.

“I didn’t feel confident enough to go into a healthcare facility and secure an endocrinologist. I was referred by an African-American male physician, who cared enough about me to refer me to an endocrinology clinic. Once I went into that clinic, I did get resistance,” Jordan said.

But that was from staff at the clinic. The doctor she finally saw was supportive and helpful.

The panelists agreed that the experiences of transgender people in metro Atlanta are quite different from transgender people living in the rest of the state. There are doctors who are willing to prescribe hormones and knowledgeable about how to do so around Atlanta, but it’s a lot harder to find doctors in other parts of Georgia, they said.

“You have to think about Georgia, really, as being two states,” said Darie Wolfson, a cisgender woman on the panel who works with the Health Initiative. “There are no providers [outside Atlanta], is fundamentally what it boils down to.”

When transgender people are able to find supportive doctors outside Atlanta, the Health Initiative has had to get creative in helping those doctors get support learning the medical side of things.

“I have a client in Columbus, their primary care provider absolutely wants to prescribe HRT. But the primary care provider doesn’t want to over-prescribe or under-prescribe or do the wrong thing. He doesn’t have enough training to act as an endocrinologist," Wolfson said.

The Health Initiative arranged for the client’s doctor in Columbus to talk with a doctor in Atlanta who has more experience and training in hormone therapy.

“The doctors do peer to peer counseling. Is it a perfect situation? No. Is it the best that we can do right now? Absolutely,” Wolfson said.

When transgender people need care that is not related to medically transitioning, their gender identity can also be a barrier.

Colbert cited the example of a non-binary focus group participant – someone who does not identify as a man or a woman – who went to the emergency room when they experienced trouble breathing. Instead of addressing the respiratory trouble, the doctor and nurse argued about whether or not they should be administered a pregnancy test, based on their gender presentation.

Necaela Penn, a panelist with LaGender, said experiences like these create a barrier to transgender people getting the care they need.

“Before you can actually get the care, you are asked about your transition and other things. They aren’t talking about what you are there for. So when you are talking about barriers, yes there are barriers,” Penn said.

 

'It’s really rough in the trans community'

 

Chanel Haley (photo), a transgender woman who serves as Georgia Equality’s transgender inclusion organize, discussed her experiences working with the trans community outside metro Atlanta.

“These stories still exist in parts of Georgia where they cannot find medical care providers that are willing to see them – for any reason. Not just for hormone replacement therapy, but they come in with a broken arm or a cold but it’s, ‘that’s your fault, if you would stop all that, the way you are, you wouldn’t be here right now,’” Haley said.

“We talk about here in Atlanta – and Grady, and Fulton and DeKalb County, Gwinnett and Cobb – of how privileged we are, if that’s what you want to call it in Georgia. But outside of metro Atlanta, it’s really rough in the trans community with just being themselves,” Haley added.

The report urges state lawmakers to consider four policy changes:

  • Enactment statewide nondiscrimination protections that prohibit discrimination on the basis of sexual orientation and gender identity in areas of everyday life that include health care, employment, housing, and public accommodations;
  • Legislation limiting the amount of out-of-pocket costs that consumers, including transgender people, pay for prescription drugs, such as HIV medications;
  • Enact policies encouraging or requiring licensed health care providers to be trained in LGBTQ cultural and clinical competency
  • A ban on the practice of conversion therapy.

Georgia Equality and progressive lawmakers pushed for a statewide non-discrimination measure earlier this year, but the legislative effort struggled to gain bipartisan support. It’s likely to return next legislative session. A measure from state Rep. Keisha Waites to ban conversion therapy has also struggled to move forward.