Mich Miller’s life affirming surgery, which took six months of therapy sessions, doctor visits, and consultations to make happen, has been postponed indefinitely. Sam, lead organiser of the New York Transgender Advocacy Group, is meant to have their surgery in May, but believes it will be cancelled. “Part of me is very rational, and knows there’s still time to have my surgery done,” says Sam, who’s luckily still under 25 and therefore able to be on their parents insurance. “Then there’s another small part that feels like it’s all so surreal. I’m in denial.”
Across the globe social distancing practices, including lockdowns and shelter-in-place enforcements, are halting many of these long awaited procedures for trans and non-binary people. “Folks may no longer be able to access medical and psychological care due to lack of medical insurance or finances needed for medical or mental health appointments, hormone therapy, and surgical interventions,” says Dr. Randi Kaufman, a PsyD based in New York.
Those waiting for surgery have had their appointments delayed while others’ are put on indefinite hold. “Not only does this cause distress — including increased dysphoria, increased depression and/or anxiety, feelings of hopelessness and helplessness, even suicidal feelings and self-harming behaviours — but it leaves a very uncertain future,” Randi explains. While these surgeries are currently considered non-emergency/non-essential, they are life-saving for many folks. By labelling them as “elective” the doctor believes it dismisses the trans and non-binary community’s value as human beings.
Antía Gómez, a first year med school student who began pursuing medicine as a profession around the same time she started transitioning, is meant to have a vaginoplasty this summer. But since it is scheduled during a tight window between her first and second year of medicine she worries the surgery could be postponed and she’ll have to take a year off from medical school. “Honestly, the fear will probably not go away until the anaesthesiologist puts me under. It’s a fear that exists alongside anger and sadness, but I’m still hopeful that it will happen, I just don’t know when.”
Outside of coronavirus, accessing these procedures typically takes a while, with some folks being on a surgeon’s wait list for up to a couple of years, while some are forced to travel outside of their state for their surgeries. “Many trans people fear that they will not be able to continue the trajectory they started on once the pandemic eases,” Randi says. “They may have to wait much longer periods of time, and may no longer have the ability to travel to another state for that surgery.” Accordingly, Mich says it is likely that they will have to go through the entire process all over again: “I have been working towards this for so long and have nerve damage from chest binding since high school. This has been so shocking to me and greatly troubling.”
When Sam came down with coronavirus symptoms a few weeks ago, getting a test was not easy. “I called 311 and I begged them to test me. I needed to know since I work with an immunocompromised community.” Luckily, healthcare providers at Callen-Lorde Community Health Center took their symptoms seriously and tested them (the centre is no longer providing tests). While they tested positive, Sam is still waiting for access to a patient portal and for their testosterone to be delivered. “I’ve had to miss many doses because I’m waiting and things are backed up.”
Access to testosterone has become more complicated due to coronavirus, since it’s a controlled substance and often must be picked up in person. This can put individuals who need it at risk of contracting COVID-19 while potentially delaying their medication. “I’m currently taking testosterone and I go in to get my shot every week,” says Chris Jay. “Since this outbreak, getting my shot has become difficult as they treat hormone injections as a non-priority.” Usually Chris can do a walk-in pickup but now the pharmacy is requiring them to schedule a full appointment with their doctor every week, ultimately costing them more money and time. Chris also requires a nurse to teach them how to administer their doses but none are available.
Access isn’t the only issue, as many individuals in the community don’t feel safe going to hospitals. “Going to the hospital, especially the emergency room, really spikes my anxiety,” Chris says. “I worry about being misgendered, discrimination, homophobia, fatphobia, transphobia, etc. All of those things have happened in the past for non life-threatening issues. What if I get sick? Would I get the same care as someone who is far less marginalised?” If a trans or non-binary person gets coronavirus, Chris is concerned that they may not get proper treatment if the wrong healthcare workers are assigned to them.
Randi’s trans clients are extremely distressed, dysphoric and depressed, with some even becoming suicidal or self-harming. “They are very anxious and unsettled about how and when they will be able to resume their transition process.” Many fear that legal protections currently in place might also be taken away, Randi adds, while some have expressed being shocked, angry and fearful about the fact that the hospital tents put up in Central Park are being run by Samaritan’s Purse, an anti-gay evangelical Christian organisation, and are worried about having to go there in a situation where they need medical care.
“Given that many trans folks have already experienced medical abuse — medical providers not wanting to touch or treat them, asking inappropriate or hurtful questions that are not related to the medical issue at hand, being misgendered and mis-named — trans folks often do copious research and seek out providers that are known to be gender-affirming,” Randi explains. “They seek providers that are knowledgeable about their experience, decreasing the possibility that they will be harmed in some way.”
Randall Leonard, a licensed clinical social worker based at a queer health resource centre in Baltimore, Maryland, has had to switch to remote sessions with their clients, many of whom can’t access technology, making it difficult to stay connected. Interestingly, they’ve also found that a lot of their clients who’ve experienced other trauma are feeling completely numb to the situation. Randall says this could be because some of them were around during the Freddie Gray riots, while others have seen their trans siblings killed in the streets. Their clients already deal with a lot of isolation and uneasiness, they explain, so this is just another added layer. In addition to this, they’ve also had to address the fact that some of their clients who use binders or corsets and, because of the respiratory concerns associated with them, could find themselves in a precarious situation since coronavirus impacts the lungs.
With schools closed, Randi worries that trans teens could be stuck with unsupportive families and less support from their peers than they are used to. “I think that must be really hard right now for a lot of trans youth in our country who find support in and are seen by their peer group but often misgendered and unsupported at home.”
“With me being trans and black, I’m hyper aware of how epidemics like HIV/AIDS affect my community at a disproportionate rate compared to others, so I’m just scared of how the COVID pandemic will affect already marginalised communities like mine,” a trans woman named Felina explains. News reports have found that black communities are particularly vulnerable to coronavirus, while according to Randi, transgender people — especially transgender people of colour — are disproportionately likely to suffer from a lack of financial stability, family support, access to jobs, and home safety in general. “Many trans folks do not have family they can turn to for support, whether it be emotional or financial, and are unable to be with community during this lockdown, such as LGBTQ centres, chosen family, going to safe spaces in public that may cater to trans and queer folks,” the doctor says.
Fear is pervasive right now and Leonard is seeing a rise in cis-gender spaces denouncing the importance of trans individuals because they feel threatened. Still, the therapist tells i-D, “I have heard a lot of younger people say ‘I’ve never seen anything like this in my life’. And luckily they have queer elders who have, with the AIDS epidemic, telling them: we have… and this is how we survived it. It’s been a source of motivation.”