Getting and paying for good healthcare can be tricky for many of us. For transgender people, it can be a much bigger challenge. But, as WMRA’s Emily Richardson-Lorente found out, the University of Virginia is turning into a kind of hub for transgender healthcare. Here's the first of two reports.

JAH AKANDE: If I can avoid going to the doctor again, I'm going to avoid going, so …

Jah Akande is a lot of things: a native Virginian, a doting husband, a stellar law student, and a proud African American. He’s also transgender.

AKANDE: I say I came out twice: came out at thirteen as a lesbian, came out again at 19 as transgender. I think that second coming out was really hard.

Jah is 26 now, and living comfortably as a man, but when he first came out as transgender, he was itching to start testosterone injections. But his family’s health insurance plan wouldn’t cover them.

AKANDE: And that was really difficult for me. Because you know at that point, when you finally realize, oh my goodness, like, I can start trying to live my life as a male, you want to do it.

For many transgender people — though not all — hormone therapy is key to transitioning. But that doesn’t mean insurance will pay for it. In fact, according to the latest US Transgender Survey, one-quarter of those who sought coverage for hormones in the previous year were denied by their health insurers. Jah eventually switched insurance and began testosterone therapy.

AKANDE: You know, I was starting to physically transition and grow a beard and you know my little voice dropped and everything.

Just what he’d hoped. But then he had a bad experience with a nurse — a nurse who could not understand why the handsome, bearded man in front of her needed the testosterone injection she was giving him.

AKANDE: And I said, "You know I'm transgender, so that's why I need it." And she said, "Trans what?" And she said "Trans what?" while the needle was stuck halfway into my body …”

And this, Jah says, was a long, thick needle.

AKANDE: And she's just like, you know, "I didn't sign up for this" and, you know, so it was a very -- it was a very visceral reaction from her.

Even when there’s no overt hostility, medical settings can feel fraught for trans patients.

AKANDE: I mean we’re in Virginia, like, it’s kind of fifty-fifty. You don’t know what you’re going to get, if people are going to be receptive or not.

Jah is training to be a lawyer, so he says he’s confident and comfortable advocating for himself. But, like the vast majority of transgender men in the U.S., about 85%, he still has a uterus, and so he has to visit the gynecologist for regular check-ups.

AKANDE: You know, if my wife can't go with me or my sister can't go with me that day, it's just really awkward.

REPORTER: So it's not the exam that is hardest for you, it's the fact that you're the only dude sitting in the waiting room?

AKANDE: Right. It's the dude sitting in the waiting room or the secretary who's known me since I was sixteen is calling me "she" still.

The research is clear: if a trans person doesn’t feel welcome or safe at the doctor, they’re less likely to go. Just like any of us would be.

CATHERINE CASEY, MD: It's really, truly astonishing. I’ve had patients who are transgender in their 60s and 70s, who are coming to the doctor for the first time in thirty years.

Catherine Casey is a family doctor at UVa. She’s taken a particular interest in transgender patients. She says that although many doctors have the best intentions, trans patients may have good reason to worry.

CASEY: I think their fears are real and legitimate.

She points to a study that shows 28% of transgender patients had been harassed in medical settings. Nearly one in five had simply been refused care. Two percent were even victims of violence in medical settings.

CASEY: I think that if I had faced some of these things, I wouldn't go to the doctor either.

And so, Dr. Casey recently helped launch the UVA medical system’s first adult transgender clinic. For one afternoon a month, Dr. Casey’s office in Crozet will be staffed by trans-friendly psychologists, endocrinologists, nurses and even receptionists. So far, they’ve held three clinic days, and served a handful of patients each time.

CASEY: One of the things that really struck me was one of those patients drove two and a half hours each way. It really speaks to the need in the state of Virginia in general.

With an estimated 34,500 transgender adults in Virginia, Dr. Casey expects demand for clinic appointments to grow quickly. Of course, transgender patients can find some services elsewhere in the region. Hormone therapy, for instance, is available at the Health Brigade and the Planned Parenthood in Richmond, at the Carilion Clinic in Roanoke, and at Augusta Health in Fishersville. But, in the last few years, the University of Virginia has emerged as a kind of oasis for transgender patients.

SCOTT RHEINHEIMER: It’s a lot better now.

When Scott Rheinheimer joined UVA as the Assistant Director for LGBTQ Student Services five years ago, trans students had to travel — sometimes weekly — to DC or Maryland for hormone therapy.

RHEINHEIMER: …while being a full-time student at UVA. I mean I remember looking at one of the deans and saying how is that equal access to education? It’s not!

Since then, the university student health center has begun offering hormone therapy — which is where Jah Akande receives it now. And, in 2016, UVA’s student & employee health insurance plans both began covering virtually the full range of trans-specific healthcare needs.

RHEINHEIMER: Counseling services, hormone therapies, top and bottom surgeries. We will cover it. And so, I mean, the institution is extremely supportive of transgender students and we try to let you know that.

Of course, for trans kids who AREN’T attending UVa, the student health center is not an option. But, the university’s Medical Center just down the road has a resource for those young people as well. We’ll learn more about that tomorrow.