Desmion Dizney recounts spending a week at an Austin mental health facility last April to get his bipolar medication adjusted. A transgender man, Dizney said doctors and medical staff routinely asked him the same question that should have been irrelevant to his treatment: “Have you had that surgery?”
“That’s the question I get from every health care provider who is not providing me hormones or who is not specifically giving me therapy for being transgender,” said Dizney, referring to whether he had undergone gender-reassignment surgery.
Dizney’s experience is emblematic of a lack of understanding among health care providers about caring for transgender patients, LGBT advocates say.
“With the increasing visibility of the transgender population, it’s becoming quite evident that there are misconceptions and questions on how to treat them as patients,” state Rep. Donna Howard, D-Austin, said in a statement. “This has implications not just for their own well being, but also for protocols in the doctor’s office, for the billing of insurers, and even for our correctional system.”
Howard, a former nurse, filed House Bill 943 last month to address problems transgender people face when searching for health care providers. The bill would establish a statewide Transgender Healthcare Advisory Committee comprised of 15 members from LGBT advocacy groups, representatives from public universities and physicians with experience working with transgender people. The committee would be the first of its kind to advise state officials on transgender health care, and recommendations could lead to enacting continuing education programs for doctors.
The committee would submit a report to Gov. Greg Abbott and other state officials by Aug. 31, 2018.
“HB 943 was filed to help determine where gaps may exist, clear up any confusion among providers, and better ensure that transgender Texans get the health care they need,” Howard said.
There are currently 58 health care-related advisory committees that fall under the Texas Health and Human Services System. Committees provide state officials guidance, and agency staff are present in many meetings to take recommendations into consideration, according to Health and Human Services Commission spokeswoman Christine Mann.
The idea for HB 943 followed conversations between members of LGBT advocacy groups and Howard’s staff, who heard stories of transgender men and women being turned away for common problems — such as abdominal pain — because of a lack of knowledge of the patient’s “full history.”
Lack of medical education
In Texas, 30 percent of transgender people reported having at least one negative experience related to their gender identity when seeking health care services in the past year. This includes being verbally or physically harassed, assaulted or even being refused treatment altogether, according to results from a nationwide survey released last month from the National Center for Transgender Equality.
The survey, which polled 1,490 transgender Texans and 27,715 people across the country, found that 22 percent of Texas respondents reported they declined to seek a physician when they were in need of services out of fear of being turned away or not receiving quality health care services because of their gender identity.
Among the problems: a lack of quality education and training at Texas medical schools on LGBT issues, said Lou Weaver, transgender programs coordinator for Equality Texas, one of the advocacy groups working with Howard’s staff on HB 943.
“People in medical school are not getting enough education — or any education, in some instances — around who trans folks are,” Weaver said.
According to a 2015 evaluation from the Association of American Medical Colleges, 73 out of 144 U.S. medical schools reported transgender health care as part of their curriculum.
The association developed recommendations for including transgender health care issues in medical school curricula.
Many of the programs provide only a cursory introduction to the topic, said Dr. Kristen Eckstrand, a resident in psychiatry at the University of Pittsburgh Medical Center who helped co-author the study..
“It’s not in a detailed way that really gets to how you actually provide this in a clinical setting,” Eckstrand said.
Lost in transition
During his inpatient visit, Dizney said tech staff and nurses consistently misgendered him, using incorrect pronouns. Dizney said one nurse went so far as to refer to him as “that.”
“It’s so black and white in that world,” Dizney said. “It can be difficult to get the services you need when you’re gray.”
According to the Transgender Law Center, many transgender people experience unique mental health issues resulting from how society views gender and gender expression, especially when individuals don’t adhere to society’s definition of gender identity by wearing corresponding clothing or getting surgical procedures.
For many transgender people, the disconnect between gender identity and birth sex can lead to gender dysphoria, distress that could potentially develop into serious medical problems and a risk of suicide and substance abuse, according to the Transgender Law Center.
This can be especially concerning given the community’s high rates of suicide, with more than 40 percent of transgender people nationally attempting suicide at least once in their lifetime compared to less than 5 percent for the general public, according to statistics from the Williams Institute at the University of California at Los Angeles.
Lindsay Lege, a licensed master’s social worker in Austin who specializes in treating transgender people, said gender dysphoria is a condition unique to the transgender community that for some starts in childhood.
Even something as simple as a physician referring to a transgender person by the incorrect pronoun could have substantive effects on mental health, Lege said.
Howard’s staff and the LGBT advocacy groups aren’t optimistic HB 943 will be advanced by the Republican-controlled House. There is no companion bill in the Senate.
“Do I really think we’re going to get somewhere? I don’t know,” Weaver said. “But at least we’re starting a conversation, and that is incredibly important in this point in time.”
Correction: This story has been updated with the correct number of medical schools reporting transgender health care as part of their curriculum, according to the Association of American Medical Colleges.