Affirming care

Discrimination in the healthcare system is a major concern for all trans people. A 2015 survey examining the lived experiences of trans people in the U.S. found that a third of the respondents had at least one negative experience related to being trans — including verbal harassment and denial of treatment. Another 24% avoided care for fear of mistreatment.

"I've had the experience of doctors refusing to treat me because they didn't know enough about 'transgenders' [a term of ignorance]," said Claire Bow, who began her medical transition in 2013 at the age of 55.

"Discrimination and/or ignorance is always destructive and not just for trans women. For years the medical establishment has systematically ignored the healthcare needs of women and minorities, including trans men and women," Bow said, adding that her best hope now is a provider who is willing to listen and learn, even if they aren't trained in trans health.

"Thinking of us only as transgender means doctors can often miss basic health needs — vaccinations, colon cancer screenings, or vaginal exams," Bow explained.

It's harder still for trans women of color. The 2011 National Transgender Discrimination Survey found that "discrimination was pervasive throughout the entire sample, yet the combination of anti-transgender bias and persistent, structural racism was especially devastating."

"As a whole there's an embarrassing amount of evidence that notes mistreatment and substandard medical care for trans people," Monge said. "That, coupled with systemic racism that exists within medical infrastructure makes it very difficult for [Black, Indigenous and people of color] to trust and receive high quality medical care."

Getting the care you need

Holly Bullion, Kind Clinic's director of clinical quality, emphasized that health screenings should be based on body parts (e.g., people with breast tissue should get mammograms). For trans women turning 50 who've been on estrogen for five to 10 continuous years, Bullion said mammograms are a must.

Additional gynecological care likewise depends on anatomy. "If a woman has had [gender-affirming] surgery, adequate estrogen levels are important to help maintain the health of the genital tissue," Monge explained.

For Scheps, who said she'll never know what it feels like for a woman who's been producing estrogen all her life to go through menopause, her experience with hot flashes is one she holds dear.

"I'm oftentimes frustrated because I can't empathize with what my cis sisters have felt their entire life," Scheps said. "I don't know what it feels like to have a period, I don't know what those cramps feel like. So this one little thing I have — that I know what a hot flash feels like — I just cherish."

Resources
National Center for Transgender Equality
University of California San Francisco's Transgender Care