I sat waiting to pick up my prescription at my pharmacy’s drive-thru, my two young children in tow, when the pharmacist’s voice came over the speakers: “Sir, do you understand what these medications are for?”

My children didn’t know yet, but I had started hormone replacement therapy several months earlier. I was still months away from changing my gender presentation and legal name.

“Yes, my doctor prescribed them to me and I understand what they’re for,” I replied as my concern grew. This was my first time picking up my estrogen at this pharmacy.

“Sir, these are female hormones. For women,” said the pharmacist. I explained that I understood, but that I had gender dysphoria and my doctor had prescribed the medication for me. There was a long pause on the other end.

“Sir, we canceled your prescription because we couldn’t figure out why a man would need female hormones,” said the voice. “You’ll have to have your doctor call us to confirm this is correct because it doesn’t make any sense.”

I was overcome in that moment by a swirl of competing emotions. Humiliation, anger, and embarrassment reigned supreme, and tears quickly began running down my face. Most of all, I was concerned that my kids had overheard. I just wasn’t ready yet to tell them that the person they thought was their dad was actually a woman.

Even though I did eventually get my prescription filled at another pharmacy several days later, what happened to me was a reminder that being trans is still not a comfortable concept in our society. Unfortunately, it’s still all too common in the US health care system.

Several weeks ago, the Trump administration announced a proposed rule that would roll back gender identity nondiscrimination protections in the Affordable Care Act, which essentially banned discrimination against trans people throughout the US. The Trump rollback was perhaps the most devastating attack on the trans community since he took office in early 2017. But even with the protections in place, discrimination against trans people ran rampant in the health care system.

Despite gains in insurance coverage for trans-specific services and procedures, a fifth of all trans people still reported unequal treatment from health care providers. Much of it stems from a lack of knowledge on how to address trans people. Systems may not allow for a preferred name or pronouns to be listed. Uninformed assumptions about trans bodies sometimes leave trans patients explaining basic care to our doctors. Often these experiences can be subtle. Sometimes they are explicit.

Several years after I came out and began living as the woman I knew myself to be, I started experiencing symptoms of a urinary tract infection (UTI), which I had had before and was familiar with. After unsuccessfully trying to find child care, I loaded my kids into the car and set off toward my local urgent care facility.

The facility was part of a larger health care group that had a medical record of my gender transition on file. When the nurse called me to the back, she had me step on a scale, again with my kids in tow, and began asking questions about my symptoms.

“How can you be sure it’s a UTI?” she asked me. I told her my symptoms and added that I was experiencing discharge. “How can you be sure it’s not vaginal discharge?” she asked, pressing further.

“Because I don’t have a vagina,” I told her flatly.

A confused look passed over her face before finally her eyes registered the implications of my words. She grew visibly uncomfortable. I suddenly panicked that my kids might witness transphobia against me.

The nurse, and eventually the doctor, began asking me detailed questions about my sex life in front of my children. They both assumed that a sexually transmitted infection was the cause of my urinary discomfort, a common form of prejudice that assumes that trans women are more sexually active than cis women.

I reassured them that I hadn’t been sexually active in months and that I had recently been tested. Still, they pushed on in their questioning, doubting my insistence that I had a simple UTI. I had to beg the doctor to order tests on my urine sample and prescribe me an antibiotic, which she eventually agreed to.

Several days later, a different nurse phoned me to confirm my UTI diagnosis and ensure I was following the correct protocol with my antibiotics. The vindication didn’t make up for the embarrassment of having to recount my sex life in front of my kids.

These experiences aren’t even the half of it, and I’m a passing, white, insured trans woman with a platform to self-advocate. What must it be like for those with even less access to insurance and the health care system at large? According to a 2015 survey from the National Center for Transgender Equality, 13 percent of trans people are uninsured in the US compared to 10 percent of the general population, and some health insurance companies still exclude transition-related care from their plans. The ACA rule that the administration is in the process of rewriting would allow insurance companies to again exclude that coverage on a wide scale, a stated goal within the religious right.

Beyond transition care, however, we face a daunting lack of compassion and knowledge from the wider medical community. Trans people might be a small demographic, but there are 1.4 million trans people in the United States, according to the Williams Institute at UCLA. We all have basic health care needs beyond just hormones and surgery. Yet doctors and other health care providers simply don’t expect trans bodies in their practices.

While there has been an expansion in trans training programs for medical providers in recent years, trans people still struggle to find competent basic care, much less trans-specific care. “Trans broken arm syndrome” — a phenomenon where every little ailment, from an infection to a broken arm, is blamed on the hormones many trans people take as a routine part of their transition — is a common occurrence within the medical community. I once had an urgent care doctor in a major metropolitan area express shock that my transition regime merely consisted of estrogen and a testosterone blocker.

“You’d think it’d be some crazy drug concoction,” he quipped to me, even though I was there for a pre-op physical. It’s just hormones, bud.

Trump’s proposed ACA rule, and an earlier proposed rule that would allow doctors to make religious objections to providing certain medical treatments, will only exacerbate the medical knowledge gap when it comes to treating trans bodies. Instead of doctors attending training on how to treat trans people with competence, Trump’s rule will allow them to just deny service altogether. Doctors could also condition care on a trans person detransitioning in any state that doesn’t already have trans nondiscrimination protections on the books.

The US trans community is now looking at a possible return to a health care environment that allowed oncologists to deny cancer care to Robert Eads, a trans man who developed ovarian cancer and was never notified of his diagnosis. When he finally learned of it, his doctor said his first instinct was to send Eads to a psychologist rather than treating his cancer. Eads died in 1999. Or Tyra Hunter, who died after an EMT discovered her trans status following a car accident and refused to touch her on the trip to the hospital, mere miles from the White House.

Trans people have seen repeated attacks from the Trump administration on our rights, but this latest proposed rule is simply a bridge too far. We cannot go back.

Correction: A previous version of this article incorrectly stated that there are 1.3 million, not 1.4 million, trans people in the United States.

Katelyn Burns is a freelance journalist based in Washington, DC. She was the first openly transgender Capitol Hill reporter in US history. Her other work can be seen in the Washington Post, Teen Vogue, Vice, and many others.

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