At the age of 24, I began a slow social transition to becoming a woman. When I was 26, I began my medical transition. Now, at 28, I realize just how much cisgender people (i.e., those who identify with the gender assigned to them at birth) misunderstand about transgender health issues.

For example, people often don’t realize that my medical procedures are not elective—rather, they’re a necessary part of my transition. I am lucky enough to have had insurance that covers breast augmentation for transgender people, but I had a cisgender girlfriend who could not comprehend why insurance would cover my breast augmentation and not hers. Plus, cisgender people often don’t understand that transitioning—medically, socially, or both—is often a matter of life or death. In fact, the suicide rate for transgender people is more than 30 percent higher than it is for the overall U.S. population, according to a University of California Los Angeles report.

Even if you're an extremely empathetic person, there’s probably a lot you don’t understand about transgender and gender-diverse health issues—and that’s okay. I'm here to break down several of the biggest ones for you.

Cheryl Seligman

I cannot tell you how many times I've been asked some form of the question: “So how long do you need to be on hormones for?” Hormone therapy is common among people in the transgender community who are transitioning. With hormone therapy, people often take what are known as “blockers.” These medications essentially minimize or stop the production of sex hormones that don’t align with the gender with which they identify and replace them with hormones that match their gender identity. For example, a transgender woman will often take blockers for testosterone and estrogen supplements.

Hormone therapy allows T/GNC (transgender/gender non-conforming) people to receive the hormones necessary to experience puberty and ultimately develop the physical characteristics that are appropriate for their gender identity. While some of the physical changes are permanent (like developing breast tissue), others are not (like breast size, which can change if someone stops taking hormones).

Getty Images

Physician assistant Diane Bruessow, who works for the private medical office Healthy Transitions, says that doctors who don’t work with transitions don’t necessarily know the details of working with hormone therapy. That’s why Alex Keuroghlian, M.D., M.P.H., a psychiatrist at Massachusetts General Hospital and assistant professor of psychiatry at Harvard Medical School, who works with transgender patients, says it’s important to find a doctor who understands the process. Unfortunately, not everyone does. “There is a huge shortage of providers who feel confident to provide gender-affirming care,” he says. “Without access to these providers, people end up using medically unmonitored hormones, like injections off the street, which can put them at risk for all kinds of health problems.”

Zil Goldstein, assistant professor of medical education and program director for the Center for Transgender Medicine and Surgery at Mount Sinai Health System, agrees that there is a need that isn’t being met. “There’s not enough education around transgender health for healthcare providers,” she says. “You’re going to get better outcomes with someone who knows what they’re doing versus someone who is just following an algorithm that they downloaded from the internet.” While there are some resources online, many people simply have to search online for doctors that offer hormone replacement therapy (aka HRT). The World Professional Association for Transgender Health has a provider database you can search to find a doctor that's right for you.

You NEED to do this the next time you go to the doctor:

​

Getty Images

None of the 50 states in the U.S. require healthcare plans to cover trans-health office visits, medications, or gender-affirming surgical interventions. Fourteen states explicitly ban exclusions for transition-related healthcare within insurance plans, according to the National Center for Transgender Equality. So even though most major medical and mental-health associations, like the American Medical Association and American Psychological Association, consider trans health to be medically necessary, state-level regulation makes it easy for health insurance plans to exclude medically necessary care for transgender and gender-diverse people. The American Psychological Association’s statement on trans health says that “appropriately evaluated transgender and gender-variant individuals can benefit greatly from medical and surgical gender transition treatments” and that the association “opposes categorical exclusions of coverage for such medically necessary treatment when prescribed by a physician.”

Under the Affordable Care Act, insurance plans have to deliver preventative services for your gender, which also apply to transgender individuals, a.k.a. the gender you identify with, says Sarah O'Leary, founder of Exhale Healthcare Advocates, a national consumer healthcare advocacy group. But the plans themselves aren’t required to offer hormone therapies, gender-confirmation surgeries, or other related care. Many plans are still choosing to exclude these services to transgender patients, she says, although most large group-employer plans cover transgender medical issues, and some even cover transgender surgeries.

Getty Images

Psychological testing of transgender children whose gender is affirmed at home and at school found these children to be psychologically indistinguishable from their cisgender peers, while decades of research by Caitlin Ryan, Ph.D., director of the Family Acceptance Project at San Francisco State University, reveals that those without family acceptance have up to an eight times greater rate of suicide and other unhealthy behaviors. Keuroghlian stresses the importance of this. “The younger somebody is affirmed in their gender, the less protracted their experience of severe minority stress is likely to be,” he says. Children who aren’t affirmed in their gender identity at home are much more likely to suffer from conditions like depressive disorders, substance abuse disorders, and even PTSD, he says.

Goldstein agrees. “Children who are affirmed in their gender at a young age grow up to be happier adults—that’s what you would expect from a cisgender child too,” she says. “If they’re not forced to live in the opposite gender role, you would expect them to grow up happier.”

Getty Images

Not everyone identifies as either male or female, and some people may never desire to fully transition to male or female, so there are more than two genders. There is no surgery or medical intervention that provides a rubber stamp of validation on someone’s gender identity. “Gender diversity is a common and culturally diverse phenomenon,” Bruessow says. “It’s a normal variation, like left-handedness, and not inherently pathological or negative.” While the U.S. restricts official gender identification to the binary, other countries may use X, T, or E on identity documents to represent genders beyond male and female.

I cannot tell you the number of times I’ve heard complaints about this from non-binary and gender diverse friends. In 2016, a court in Oregon granted recognition of nonbinary gender for the first time in the U.S. However, without federal recognition of non-binary gender identities, transgender people can’t get a passport from the U.S. Department of State.

While a patient-centered approach to gender-affirming care is advised, healthcare professionals often miss this opportunity. For example, a trans-masculine friend of mine, who has had top surgery and is not on hormones, is constantly asked by healthcare professionals, “When are you starting testosterone?” They are in turn flabbergasted when the answer is never. This is especially true for those whose gender identity is neither male nor female. It is imperative to understand that medically transitioning to any degree is a personal choice and that it is about expressing one’s own authenticity, not about conforming to societal expectations of what gender is. That validation only comes from their heart and truthful lived experience.

Getty Images

For people who have a cervix, pelvic exams are still a must, regardless of gender identity. So the next time you see a man at the gynecologist’s office by himself, don’t give him any side-eye! “It’s difficult enough for someone assigned female at birth who is male-identified to muster up the wherewithal for a pelvic exam, but when services are delivered in pink rooms with signage for 'women’s this' and 'women’s that,' it’s no wonder it’s triggering.” says Bruessow. “Topics like family planning and safer sex aren’t served when a healthcare provider still uses the outdated question, 'Do you have sex with men women or both?' which tells them nothing about anatomy or behaviors.”

Planned Parenthood spokesperson Catherine Lozada says the organization is “proud” to provide information and healthcare to transgender people. The organization’s health centers provide cancer screenings, STI testing and treatment, birth control, and other healthcare services for people of all genders. Planned Parenthood health centers in 17 states also offer hormone-replacement therapy—either estrogen or testosterone—for transgender patients. From 2013 to 2015, there was an 80 percent increase in Planned Parenthood affiliates that reported offering hormone-replacement therapy for transgender patients, Lozada says.

Getty Images

For some trans and gender-diverse people who are uncomfortable having visible breasts, binders are the name of the game. Binders are extremely tight undergarments that flatten the breasts to give the appearance of a more masculine chest. Some who can’t afford binders will use bandages or tape. All of these things over time can cause compressed ribs, breathing problems, skin irritation, and bruising. The first-ever study on binding entitled “The Binding Project” revealed “97.2 percent of participants reporting at least one negative outcome they attributed to binding. The most commonly reported outcomes were back pain (53.8 percent), overheating (53.5 percent), chest pain (48.8 percent), shortness of breath (46.6 percent), itching (44.9 percent), bad posture (40.3 percent), and shoulder pain (38.9 percent)." This is yet another example of why removing health-insurance exclusions is such an important issue—so that top surgery can be more accessible for those who need it and the aforementioned issues associated with long-term binding can be avoided.

Getty Images

Early on in my transition, I would avoid drinking any liquid. I wanted to dehydrate myself so I wouldn't have to pee. Because if I had to pee, I had to use a public bathroom. Problems that can arise from holding it in for long periods of time may include urinary tract infections, kidney stones, and kidney infection.

Goldstein points out that a lot of transgender women take a testosterone-blocking medication that’s also a diuretic, making this even more difficult for trans women. Keuroghlian says there have even been stories of security guards going into a restroom and making a transgender person leave. “This is the kind of experience people have,” he says. “You can imagine the extent you would want to protect against that. It just is debilitating.”

Additional reporting by Korin Miller.

This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. You may be able to find more information about this and similar content at piano.io