Investigation
Lost inTransition
Understanding West Virginia's transgender health care system
According to a national study conducted by The Williams Institute in Jan. 2017, West Virginia had the highest population of teens, ages 13 to 17, who identified as transgender, but according to data recently collected by Fairness West Virginia, 70 percent of transgender West Virginians said they delayed accessing healthcare due to fear of discrimination.
By Joelle Gates
March 26, 2020
Despite facing obstacles during the beginning of her transition, Natasha Stone, the transgender visibility coordinator for Fairness West Virginia, a statewide civil rights advocacy organization dedicated to the equal treatment of LGBTQ West Virginians, was able to find her way to medical resources, even if it meant chipping in while creating these resources.
As discussions related to transgender individuals begin to grow throughout the state, providing the community an attempt to become normalized, resources related to trans care are also beginning to grow throughout the nation. In West Virginia this process has been slow, providing limited opportunities for trans care.
While the state has historically been bombarded with various health issues over the past decades, the condition of West Virginia’s transgender health care system, or the lack thereof, may be one of the next issues the state must face.
“When I came out eight years ago I went to a physiologist in Morgantown and I had to teach her how to treat me,” Natasha Stone said. “That’s not uncommon for trans people.”
In order to combat this absence of options, Stone and Fairness West Virginia have begun to lead the change in West Virginia by providing statewide health trainings aimed at improving healthcare experiences for transgender citizens. These trainings, which are hosted by Stone, provide medical professionals with the information that can make “make or break” a trans individual’s experience at the doctor, according to Stone.
“This is a thing we’ve had happen in the state. Trans people have had to train their doctor on what to do,” Stone said. “People shouldn’t have to go to the doctor and tell them how to treat something they should know how to treat.”
From these trainings came a new, comprehensive healthcare guide which intends to provide information related to transgender friendly clinics and trans educated health providers for those interested in medically transitioning. According to Stone, the guide, which was also produced by Fairness West Virginia and released in Feb., was the product of the trainings.
“Before I came on, Fairness West Virginia put out a call out for information about the state of healthcare for trans people in the state of West Virginia and heard a lot of horror stories,” Stone said. “The guide is the natural extension of the (trainings). We wanted to let people know where doctors are and where they could receive quality healthcare.”
The collected data set a baseline of insight centered around the experiences that trans West Virginians may face when navigating the state’s healthcare system. Stone said that among the topics researched were experiences of discrimination, necessary travel to receive care and the impact of medical costs.
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For Evan Wiseman, a 21 year old trans man from Parkersburg, West Virginia, the journey to transition brought on many of those obstacles due to a lack of resources and general understanding about transgender individuals.
“Starting in 2014, my parents, eldest sister and I searched all throughout the state looking for hormone therapy before I eventually started. We looked everywhere but eventually accepted the fact that I would have to travel to Cleveland Clinic,” Wiseman said. “All of the primary physicians in Parkersburg weren’t interested in helping me.”
Due to the lack of resources in the state, trans individuals, such as Wiseman, are often times left to travel out of state in order to receive the care they need. In their surveying, Fairness West Virginia found that 36% of transgender West Virginians traveled out of state to receive care while 46% of transgender West Virginians had to travel more than one hour to receive care.
In addition to a lack of resources, Wiseman said that trans West Virginians may also travel extended distances in order to receive educated, understanding care from medical professionals who are knowledgeable on how to interact with transgender individuals.
In Wiseman’s experience, he said that any time he’s received care from an emergency room be has been treated “extremely poorly.”
“(Doctors) in the ER will use she/her pronouns because my gender is not legally changed and they’ll ask for my dead name even though I list my preferred name,” Wiseman said. “Often times male doctors wont even look me in the eyes and will say the bare minimum to me.”
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While recently receiving care for kidney stones at Ruby Memorial Hospital in Morgantown, West Virginia, Wiseman said he felt “violated and not care for” after receiving care from one of the physicians.
“I had a doctor who was using a scope for a vaginal procedure and, before telling me what was going on, he started and procedure,” Wiseman said. “When I made a sound because of the pain, he told his nurses to restrain me and told me to be quiet because its ‘not that bad.’”
Stone said that because of an absence of information, as well as the cultural obstacles that LGBTQ individuals face, instances such as Wisemen’s experience in the emergency room, happen frequently according to Fairness West Virginia’s surveying.
In regards to mistreatment in a medical setting, data collected by Fairness West Virginia found that 60% of transgender West Virginians said a health care provider intentionally misgendered them. 20% of transgender West Virginians aid they had been refused care due to their gender identity and 25% of transgender West Virginians said that unrelated health issues were blamed on their gender identity.
In order to battle these statistics, Stone said that medical trainings have expanded to include everyone who works at the practice, not physicians.
“When we’re training doctors or nurses, we make a big deal to say that you could be the best doctor for trans people… but if your front end staff is terrible you will lose patients. We make a big deal of saying that everyone in the clinic needs to be trained,” Stone said.
Even still, outside of obstacles created by a lack cultural differences and a general lack of understanding, trans individuals may still come into contact with barriers that prevent them from receiving the care that Wiseman deems “life threatening.”
Once Wiseman decided to look into top surgery, a medical procedure which removes breast tissue to produce a masculine appearance, he said that finding the one — and only — trans educated surgeon in the state wasn’t hard, but trying to get the procedure covered by insurance was difficult.
“I was supposed to get surgery heading into my senior year of high school in 2018 but my insurance said they wouldn’t pay for it until I turned 18,” Wiseman said. “Come November 2018, I turned 18 but the insurance said they wouldn’t pay for it because it was elective, despite receiving numerous letters from my therapists about how the surgery could save my life.”
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In order for Wiseman to eventually receive the procedure, he and his family had to pay $7,000 out of pocket.
According to Stone, in contrast to Wiseman, the cost of medical care can be debilitating to West Virginians, but can be particularly troublesome for LGBTQ citizens who have historically been shown to live in poverty.
While the degree to which trans related surgeries are covered by insurance may be low, Wiseman believes that if initiatives, such as those being pushed by Fairness West Virginia, can create conversations about changing the living conditions of trans citizens, then maybe insurance providers will begin to become open with their coverage.
For now, despite all its challenges, Wiseman said that the best thing that medical professionals in West Virginia can do to improve the condition of its transgender services is to simply recognize the presence of the community in the state and attempt to make them feel as safe as possible.
“Trans people need to talk about things that might make cisgender people uneasy, so being prepared for those moments will help make a patient feel more secure,” Wiseman said. “[Doctors] should respect pronouns and names, even if they are not changed legally. Most importantly, ask [the patient] if anything you need to do causes them discomfort or Dysphoric reactions.”
Stone said that while these things questions may seem like common sense, some may still be unfamiliar with transgender individuals or have misconceptions about the community. Stone said these misconceptions, which have the potential to be harmful for individuals like Wiseman and herself, strengthen the need for more healthcare trainings centered around LGBTQ issues.
“Everyone has been really receptive so far,” Stone said. “After the trainings, doctors say they’ve learned a lot of stuff they didn’t know, which is good that they’re getting this training, but kinda horrifying because this would be common sense to some.”
Despite insurance refusing to cover his top surgery, a procedure which removes breast tissue to produce a masculine appearance of the chest, Wiseman was still able to receive the procedure from Dr. Cristiane Ueno, the only surgeon who was willing to aid transgender citizens in the state. Shortly after Wiseman's surgery, Dr. Ueno relocated out of state.
Despite its issues, Wiseman said that he is hopeful for the future of trans West Virginians In an ideal world, Wiseman said all he would want is for a medical professional to see him for exactly what he is; himself.
“I want doctors who will listen to me, respect me and view me as a fellow human being. I don’t want doctors who will just tell me they don’t know and pass me off to someone else like I am a problem,” Wiseman said. “We need doctors who are good people that are passionate and knowledgeable on all healthcare, even ours.”
To access the Transgender Healthcare Guide, or to find more information about Fairness West Virginia, visit fairnesswv.org/transhealthguide/#list.