Tuesday, December 13, 2016

2015 Trans Survey (Cont.)

Today I am reviewing health care and there are a number of important issues that the 2015 Transgender Survey full report covers. The first section covers an area where I have problems and this is the problem area that I have,
Thirteen percent (13%) reported that they were denied coverage for services often considered to be gender-specific, including routine sexual or reproductive health screenings (such as Pap smears, prostate exams, and mammograms). Seven percent (7%) reported that they were denied coverage for other routine health care.
Every year I have to fight for my insurance to cover a prostate exam… you don’t get them if you are a woman. So I have to keep telling the doctor’s billing office to add Code 45 or KX to the comment area.

The survey goes on to report…
Negative action or policy by health insurer
  • Denied coverage for transition-related surgery: 55%
  • Covered only some of the surgical care needed for transition (respondent could not get coverage for treatment they needed): 42%
  • Denied coverage for transition-related hormone therapy: 25%
  • Covered surgery for transition, but had no surgery providers in their network: 21%
  • Refused to change records to list current name or gender: 17%
  • Denied coverage for care often considered gender-specific because of transgender status: 13%
  • Denied other routine health care because of transgender status: 7%
These all should be covered under the ACA or Medicare and also if you are in a state that offers protections for us you should be covered… but if you have ERISA coverage it maybe iffy.

There is a lot more depressing data…
Denied coverage for hormone/surgery therapy in the past year:
  • Overall: 25%/55%
  • Medicaid only: 29%/55%
  • Medicare only: 14%/48%
  • Multiple insurance types: 26%/55%
  • Private insurance only: 20%/55%
  • Other insurance only: 21%/54%
And how were we treated when we did go to the doctors?
Of respondents who currently had health care providers, 40% reported that all of their current health care providers knew they were transgender, 13% reported that most knew, and 17% reported that some knew that they were transgender. Nearly one-third (31%) of respondents reported that none of their health care providers knew they were transgender.
I just went to a new doctor last week; he was an orthopedic doctor who I went to check if I had broken my toe when I stubbed it at night (moral to story… don’t walk in the dark barefooted) and he “bed side” manor was excellent, his staff was excellent and he was excellent. They all didn’t have any problems with me being trans and the topic never came up during the exam.
Of those who had seen a provider in the past year, 62% said that at least one provider they saw knew they were transgender and treated them with respect. However, one-third (33%) reported having at least one negative experience with a doctor or other health care provider related to being transgender, including having to teach the provider about transgender people in order to receive appropriate care (24%), being asked invasive or unnecessary questions about being transgender not related to the reason for the visit (15%), or being refused transition-related health care (8%).
I never had any problems with doctor asking questions that were not about my immediate healthcare concerns. I only had one doctor that I think might have had a problem with me being trans but he did treat me okay and never said anything and he worked in the hospital where my endo was located and the appointment was arranged through her office.

When I took the survey I was one of the people who checked off this box,
They had to teach their health care provider about transgender people to get appropriate care: 24%
I had to teach one doctor about trans patients, but he asked respectfully and even though I didn’t like teaching him and thought it would have been nice to learn that in college, I did talk to him for about a half hour and when I left his office was backup with patients.
Cost was one factor in not seeing a healthcare provider (33%), fear of being disrespected or mistreated as a transgender person was another factor (23%), and gender had a lot to do with healthcare avoidance,

…transgender men (31%) being more likely to avoid care out of fear of discrimination than transgender women (22%) and non-binary respondents (20%).
Hmm… trans men avoided healthcare providers more than trans women, interesting because I would have expected the opposite.

Okay, this is one area where I am interested in,
More than three-quarters (77%) of respondents said they wanted counseling or therapy for their gender identity or gender transition at some point in their life, but only 58% of respondents have ever received counseling or therapy. While transgender men and women (81%) were only slightly more likely to have ever wanted gender related counseling than non-binary respondents (70%), transgender men and women were more than twice as likely to have actually had counseling (73%) as compared to non-binary respondents (31%). Access to counseling varied greatly by income, with those who reported having no individual income (39%) and those who earned an income of $1 to $9,999 (48%) being much less likely to have received counseling than those who earned $50,000 or more (76%).
I know that here in Connecticut mental healthcare is covered by Husky (Medicaid) and a number of trans people who contact me have been able to find a mental healthcare provider.

The report goes on to discuss various type of treatment sought and how easy/hard it was to find it.

Another area that caught my attention was,
Experiences of Respondents With Male on Their Original Birth Certificate
  • Among respondents who had male on their original birth certificate, hair removal or electrolysis was both the most commonly reported and the most commonly desired procedure. Forty-one percent (41%) have had hair removal or electrolysis, and 11% had received voice therapy, the second most commonly reported procedure. Regarding surgical procedures, 10% of respondents had undergone vaginoplasty and/or labiaplasty,23 9% had an orchiectomy,24 6% had undergone facial feminization surgery,25 8% had augmentation mammoplasty (top surgery),26 4% had a tracheal shave,27 and 1% had undergone voice surgery. These experiences varied by gender identity, with transgender women being more likely to have had the procedures than non-binary respondents who had male on their original birth certificate.
  • Two percent (2%) of respondents with male on their original birth certificate had their first transition-related procedure (not including hormone therapy) before the age of 18. Nearly one-quarter (23%) had their first procedure between the ages of 18 and 24, 32% had their first procedure between the ages 25 and 34, and 43% after the age of 34.
And our health is generally very good.
Nearly half (45%) of respondents said their health was “excellent” or “very good” and one-third (33%) said it was “good.” Twenty-two percent (22%) said it was “fair” or “poor”, compared with
18% of the U.S. general population.
And once again,
Family support was associated with an increased likelihood of reporting excellent or very good health. Respondents who were out to their immediate family and described their family as supportive were more likely to report excellent or very good health (52%) than those whose families were neutral (42%) or unsupportive (38%).
Having family support really makes a big difference!

A couple of statements by the survey respondents…
“I spent decades torturing myself into depression because I was certain that coming out would destroy my life. I did everything I could to get my transness to go away but it left me physically and psychologically weak, and on the verge of suicide.”

“I have struggled with depression and anxiety ever since puberty. I’ve failed classes, isolated myself, and considered suicide because of this. A year ago, I felt hopeless and had daily suicidal thoughts, and today I’ve got a plan for the future and haven’t had a serious suicidal thought in months. I firmly believe this is because of my transition. I feel so much more comfortable and happy than I’ve ever been.”
I had panic attacks before I transitioned which went away once I transition, it was the stress of hiding half of my life and once I transitioned all that stress disappeared.

The next chapter is about Conversion Therapy…
Many transgender people discuss their gender identity with professionals, such as health care providers or religious advisors. However, despite the medical consensus that efforts to change someone’s gender identity or stop them from being transgender (“conversion therapy”) are ineffective, harmful, and even abusive, some professionals still attempt to do so. Additionally, some transgender people feel pressure to hide their gender identity or to go back to living according to the gender they were thought to be at birth (“de-transition”) for a variety of other reasons. For example, some transgender people are pressured to avoid or put off their transition, or to de-transition after they have started their transition, by family members or employers, as well as religious advisors or health professionals. Others face significant discrimination when they begin transitioning, like losing their jobs or home or being rejected by their family or friends, and may decide to temporarily delay or even reverse their transition as a result.
Supposedly there are five religious camps here in Connecticut that does Conversion Therapy.
  • Thirteen percent (13%) of respondents reported that one or more professionals, such as a psychologist, counselor, or religious advisor, tried to stop them from being transgender.
  • Eight percent (8%) of respondents had de-transitioned temporarily or permanently at some point, meaning that they went back to living as the gender they were thought to be at birth for a period of time.
  • The majority of respondents who de-transitioned did so only temporarily, and 62% were currently living full time in a gender different than the one they were thought to be at birth.
  • Respondents who de-transitioned cited a number of reasons for doing so, including facing too much harassment or discrimination after they began transitioning (31%), having trouble getting a job (29%), or pressure from a parent (36%), spouse (18%), or other family members (26%).
Some of the more troubling findings,
Participants who had a professional try to stop them from being transgender were:
  • Far more likely to currently be experiencing serious psychological distress (47%) than those who did not have the experience (34%).
  • More likely to have attempted suicide (58%) than those who did not have the experience (39%).
  • Nearly three times as likely to have run away from home (22%) than those who did not have the experience (8%).
  • More likely to have ever experienced homelessness (46%) than those who did not have the experience (29%).
  • More likely to have ever done sex work (18%) than those who did not have the experience (11%).
The self-harm by those who had Conversion Therapy is scary and sad.

That there is so much internalized transphobia by us that we will try anything to be “cured” and for parents there is so much fear about having a child who is gay, lesbian, bi, or trans that they are willing to risk their child life.

Then the report goes on to discuss de-transitioning.
  • Reasons why respondents de-transitioned, at least for a little while
  • Pressure from a parent: 36%
  • Transitioning was too hard for them: 33%
  • They faced too much harassment or discrimination as a transgender person: 31%
  • They had trouble getting a job: 29%
  • Pressure from other family members: 26%
  • Pressure from a spouse or partner: 18%
  • Pressure from an employer: 17%
  • Pressure from friends: 13%
  • Pressure from a mental health professional: 5%
  • Pressure from a religious counselor: 5%
  • They realized that gender transition was not for them: 5%
  • Initial transition did not reflect the complexity of their gender identity (write-in response): 4%
  • Financial reasons (write-in response): 3%
  • Medical reasons (write-in response): 2%
  • A reason not listed above: 35%
I know a couple of trans people who de-transitioned. One did it because she couldn’t find employment and moved back in with her wife’s parents (I lost contact with her when she moved back to Kansas) and the other did it because of employment pressures (she did retransition).

The report then reported on another area of concern for us.

  • Forty percent (40%) of respondents have attempted suicide at some point in their life, compared to 4.6% in the U.S. population.
  • Forty-eight percent (48%) of respondents have seriously thought about killing themselves in the past year, compared to 4% of the U.S. population, and 82% have had serious thoughts about killing themselves at some point in their life.
  • Nearly one-quarter (24%) of respondents made plans to kill themselves in the past year, compared to 1.1% of the U.S. population.
  • Seven percent (7%) of respondents attempted suicide in the past year, compared to 0.6% in the U.S. population.
  • More than two-thirds (71%) of respondents who have attempted suicide have done so more than once in their lifetime, with 46% of those who have attempted suicide reporting three or more attempts.

I am one of the lucky ones who have never had suicidal idealizations but I am helping with someone who has self-harm thoughts last week. We have been trying to take the person’s thoughts away from the idealizations by calling the person every day to check how the person is doing, so far the person hasn’t try to carry out any of the thoughts.

The next section I plead guilty…

  • One-quarter (25%) of respondents used marijuana within the past month, compared to 8% of the U.S. population.
  • Seven percent (7%) of respondents used prescription drugs that were not prescribed to them or used them not as prescribed (“nonmedical prescription drug use”) in the past month, compared to 2% of the U.S. population.
  • Four percent (4%) of respondents used illicit drugs (not including marijuana and nonmedical use of prescription drugs) in the past month, and 29% have used them in their lifetime.
  • Overall, 29% of respondents reported illicit drug use, marijuana consumption, and/or nonmedical prescription drug use in the past month, nearly three times the rate in the U.S. population (10%).

I must confess that I use marijuana since college back in 1970 and back then I tried psychedelic drug including LSD. But in my defense it was the late 60s and the early 70s and just about everyone was doing something. It was the era of peace, drugs, and rock-n-roll. I even smoked with the police (no not the rock band but those in the blue uniform). Also I went to college in Rochester and one of the students had a job at the plant were they made “Black Beauties” and his nickname was “Speed.” I never really got into alcohol; the dorm was divided between the alkies and the druggies.

The survey next delves into AIDS/HIV.
Respondents were asked whether they had ever been tested for HIV, aside from testing obtained through the blood donation process. More than half (55%) of respondents had been tested for HIV, in comparison to 34% of the U.S. adult population. This varied by gender identity, with transgender women (62%) and transgender men (58%) being more likely to be tested, compared to non-binary people (45%). Black respondents (70%) and American Indian (65%) respondents were more likely to have been tested than other people of color and white respondents.
I’m at very low risk and I have been tested when my kidneys were acting up and the test was negative.

The next chapter is on Education.

A busy day today. I have a meeting in the morning with a social worker who want to start a profession mediated support group at the Hartford Gay and Lesbian Health Collective where I volunteer two days a week. Tonight I will be at the National Association of Social Workers (NASW) to review workshop proposals for their spring conference. 

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