Supporting the Healthcare Needs of Transgender People in Montana

Shawn Francis lives in Bozeman, Montana, but he travels over an hour and a half to Helena to see the doctor. He also had to wait three months for his first appointment with an endocrinologist.

Long distances and long waiting periods are common experiences for Shawn and other transgender people living in rural areas.

“Transgender people have a network,” he said. “When someone finds a doctor that’s supportive, the word spreads. There are so many horror stories—so much unacceptance and judgment—that, for the most part, people try not to put themselves in situations where they won’t have their needs met.”

Shawn is currently seeing both a primary care doctor and an endocrinologist, but he doesn’t feel as though either of them think holistically about his care.

“I’ve never felt like either of them was invested in me or my care,” he shared.

Adding to the challenge, Shawn is also paying for all of his medically-necessary care—including hormone replacement therapy, several different routine tests, blood panels, and mental healthcare—out of pocket because insurance won’t cover it. Reducing the cost of his care would have a huge impact on his quality of life.

“Right now I’m choosing between saving money to get training for my career path, or for surgery. That decision is huge, and it’s crushing,” he reflected. “It’s not fair to have to choose between being yourself and working toward the future that you want to have.”

Another barrier to care for many transgender people is a general fear of going to the doctor.

“I was having sharp pains in my lower abdomen awhile back, but I didn’t feel like I could go and see someone about it,” Shawn remembered. “So I just waited it out and hoped that the pain would subside. I didn’t want to have to go see the gynecologist as a guy.”

This fear is rooted in the discrimination and harassment that many transgender people face on a daily basis.

“One Sunday, a woman spoke in front of my church congregation. She wanted financial support for her health clinic and was talking about their different programming,” Shawn recalled. “Literally the next day, I saw the same woman at the Bozeman City Council meeting where they were discussing whether or not to establish a non-discrimination ordinance (NDO) to support Bozeman LGBTQ residents from discrimination. She got up to testify and said she did not support the NDO because she didn’t want to treat transgender people at her clinic.”

The barriers and challenges that Shawn has experienced while attempting to access the care he needs highlights how much work there is to do before transgender people gain equal access to proper and medically-necessary healthcare and are treated with dignity and respect by providers. And that is only part of the problem.

“Even if you find a doctor who is trying to be supportive, odds are they haven’t treated someone who is transgender before,” Shawn explained. “You have to teach them how to treat you. Often, you find someone who is supportive that you have a history with, and they don’t feel comfortable covering this part of your healthcare because they haven’t done it before.”

In the National Transgender Discrimination Survey, 50 percent of survey participants reported having to teach their medical providers about transgender care.

To help address these issues, Pride Foundation recently made grants to two Montana-based organizations that are increasing access to culturally-competent, affordable care for the transgender community—Bridgercare and Gender Expansion Project.

Bridgercare’s Quality Care for Underserved LGBTQ Project is working to increase access to friendly, quality care for LGBTQ people living in south central Montana by providing services, education, and outreach on a sliding fee scale.

Partnerships with local organizations will allow Bridgercare to establish protocols based on best practices for providing hormone therapy, mental healthcare, and related services, in addition to offering trainings to providers and staff. With this grant, Bridgercare is also working to adapt their clinic culture, marketing, and outreach strategies to be more LGBTQ-inclusive—ensuring that people feel safe and respected when they visit the doctor.

Pride Foundation’s grant to Gender Expansion Project is supporting the Gender Expansion Trans* Health Conference, which will take place in Missoula, Montana in October 2015. The event will be a one-of-a-kind opportunity to bring together a variety of different stakeholders—medical and mental healthcare providers, community organizers and activists, teachers, professors, professionals, individuals of gender diversity, their peers, and supportive families—for educational trainings, workshops, and networking. It is the only conference of its kind between Seattle and Philadelphia.

Increasing culturally-competent, affordable healthcare for the transgender community will drastically improve the health and well-being of our community, while ensuring that everyone has access to the healthcare they need and deserve.

For Shawn, this increased focus on healthcare access for the transgender community is vital; “At the end of the day, I just want my body to reflect the person that I am.”

Zachary Pullin is Pride Foundation’s Communications Manager. Email Zachary. 

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