“It’s easier to write us off in a crisis”: Classification of gender-affirming surgeries as “non-essential” further delays transitions

Yunkyo Kim, Assistant Campus Editor

Content warning: this article mentions suicidal thoughts.

Michael Ann DeVito was done with waiting.

The Northwestern doctoral student said she promptly began receiving hormone replacement therapy and other treatments after coming out in 2019 as transgender.

“Not many people come out as trans and then want to take a big pause,” the 34-year-old said. “And once you come out as trans, you kind of want to do the thing, whatever it is going to be.”

Receiving estrogen through hormone replacement therapy makes facial skin sensitive. Shaving every day made her face bleed, DeVito said, but there was no option to stop because she was attending professional meetings and teaching over Zoom.

DeVito scheduled a series of laser hair removal treatments, which would have concluded by May, but COVID-19 policies shuttered dermatologists and all “elective” procedures. The significant delay in the timeline negatively contributed to her gender dysphoria and mental health, she said.

These experiences are not universal to the transgender community, she said. Self-identity, procedures and treatment timelines look very different across patients and geographic locations. The COVID-19 pandemic and emergency responses, however, have reduced access for necessary treatments across the board, significantly extending the timelines for transgender individuals who seek treatment.

In March, the American Hospital Association sent a letter to Surgeon General Jerome Adams recommending a “blanket directive” to cancel or delay all elective and non-urgent procedures. Following months of these delays, the Illinois Department of Public Health announced that hospitals and medical centers may begin conducting elective procedures again, starting May 11.

Each institution also needs to adhere to a stringent set of rules and may at any time discontinue procedures due to epidemiological patterns, capacity or resources. It also mandates that each medical facility assemble a Surgical Review Committee to prioritize certain elective cases previously postponed. This may mean more logistical difficulties and mental stress for those whose timelines are further delayed.

The road to receiving safe and adequate treatment has already been complicated for some in the Northwestern community.

Doctoral student Erique Zhang said they started hormone replacement therapy in late 2016 while living in New York. When they moved to Chicago to study at Northwestern in October 2018, they originally went to Howard Brown Health, a healthcare organization for LGBTQ+ individuals.

Zhang said the first provider they saw at the center was understanding, but that provider soon moved locations. The second person they met was unwilling to listen to their self-evaluations of the treatment, they said. Zhang then began going to the Chicago Women’s Health Center to see more helpful providers.

When Northwestern University Health Services began administering hormones, they switched to that service because it cost less. But Zhang could tell, while well-meaning, that the doctors didn’t have an understanding of how to treat transgender patients yet.

“I kind of felt like (my doctor) was treating it like an experiment or a learning process for (himself),” they said. “My understanding is he took it upon himself to get the training to do that, no one directed him to. He understood that there was a gap … but it feels like it’s been a slow process in terms of getting even one doctor in the entirety of NUHS to know how to read hormone levels.”

The difficulty in receiving refills on their prescriptions due to COVID-19 adds to the complex chain of access.

In New York, where Zhang is currently staying, pharmacists are legally bound to provide one authorized refill when the recipient transfers pharmacies. However, the pharmacy at NUHS has been authorizing three refills — which means Zhang is losing refills even though they have no choice but to get prescriptions in New York state.

Dr. Kevin Hatfield, a family medicine specialist based in Seattle, said receiving adequate treatment at an acceptable timeline is important for patients.

“Some patients, if they’re misgendered when they’re in public, that can be extremely stressful,” Hatfield said. “The term microaggressions comes up because a lot of patients just feel like they’re always being perceived in the wrong way. And that can just be really anxiety-provoking and very, very stressful over the course of time.”

Many transgender and gender non-conforming individuals at Northwestern experience these microaggressions. According to Genderqueer, Non-Binary, and Transgender Student Priorities and Experiences, a 2019 survey report by the Queer Pride Graduate Student Association and other campus groups, 83 percent of respondents stated they were called by a wrong pronoun by strangers and acquaintances. Another 62 percent of respondents reported being told they “complained” too much about gender-nonconforming people and issues.

Among the same respondents, 34 percent said they experienced difficulty accessing physical and mental healthcare.

Communications freshman Sadd Sadd received approval for top surgery, a gender-affirming treatment that reconstructs the chest, before Spring Break. He planned to complete it in June or July.

Sadd said his parents were not supportive of him receiving top surgery and have had difficulty acknowledging his identity since he was a young teenager. He said he worked in restaurants for four years prior to attending Northwestern, saving up for the procedure. When he heard the pandemic was forcing doctors to cancel surgeries, he said he knew he would be impacted.

In middle school, Sadd said his gender dysphoria impacted his mental health. When he presented as a traditionally feminine person to gain acceptance from his environment, he said he felt like he was wearing drag. The experience, he said, led to depression and suicidal ideations.

Sadd said he reached out to his doctor and patient care coordinator about the status of his procedure and did not immediately hear back.

“I don’t think anyone would want to pay upwards of $10,000 for surgery or I don’t think anyone would really want to be born with body parts that make them feel so terribly that they feel like they have to transition,” he said. “When they hear the word ‘elective’ being attached to the idea of having a surgery that they feel is necessary, it just invalidates that experience and reminds them of other times that they’ve been invalidated when speaking about their own identity.”

Sadd acknowledged that he understands the surgery was postponed for COVID-19 related issues, adding that he didn’t see the situation as unfair. However, the classification of gender-affirming treatments as elective contributes to transgender people’s reservations about doctors and medicine, he said, which have been compounded over time by a field that enforces the gender binary.

After coming out, DeVito planned to visit her family in Connecticut, meeting her parents for the first time as their daughter. Due to the pandemic, she will not be able to visit them this summer. And while she understands the need for social distancing, she’s disappointed to miss out on other fulfilling opportunities like dating, an experience she had hoped to redefine for herself.

Compounding the isolation, she said, is the fact that necessary procedures for transgender individuals have been “trivialized” as cosmetic by cisgender policymakers and medical establishments. But this is part of a continuing trend, she said. It’s easy to ignore trans problems during a pandemic because they’ve “been writing them off for years.”

“It’s not a vanity thing,” she said. “It’s a core identity and ‘feeling like your body is yours’ thing. And when we call things like that cosmetic, it’s not just incorrect. It’s goddamn insulting.”

Email: [email protected]
Twitter: @yunkyomoonk

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