access to care for transgender people

For transgender people in Illinois, strong access to health care offers relief

Thirty years ago, when he was only 3 years old, Tristan Connor knew he did not identify as a girl, even though he had been assigned a woman at birth. He didn’t have the words to say it then or even later in his teenage years. Growing up in the 1990s and early 2000s, Connor had no role models for transgender behavior, social media, or YouTube to help him find other people like him or expose him to the vocabulary he used. dreamed.

It wasn’t until his late twenties that he realized he identified as a man. Then he embarked on a series of gender affirming surgeries – including a double mastectomy to remove her breasts, hysterectomy to remove his uterus and phalloplasty to form a penis – which helped him become what he is today.

The National Center for Transgender Equality describes transgender people as “people whose gender identity is different from the gender one thought they were at birth.” In 2018, the Chicago Department of Public Health estimated that approximately 10,500 people who identify as transgender live in Chicago, or about 0.5% of the population.

Governor JB Pritzker has been a strong advocate for protecting the rights of transgender people. In 2020, the state of Illinois affirmed that people cannot be discriminated against because of their sexual orientation or gender identity. Prior to that, in 2019, Pritzker signed an executive order aimed at protecting transgender students.

But in other states the situation is very different. In 2021, more than 35 bills were introduced across the country that would limit the access of minors to gender-affirming surgeries.

Trans transitions

Connor, who recently moved to St. Louis area but returns to Chicago for medical care, openly shares his experience with others who seek their own path, including young people. Every two weeks, he volunteers his time to speak with an online group of 13, 14, and 15-year-old teens who identify as male and who live in a southwestern Chicago suburb.

He assures them that they can have a fulfilling life as a transgender person. “They say to me, ‘Can I have a girlfriend? Can I have a job? ‘ And I’m like ‘Yes!’ He said.

When I was in puberty it was very depressing for me. I literally felt like my body was changing in a way that I didn’t want to. “

Many of the group have recently started taking testosterone and often talk about the pressures they feel in school. They also talk about what’s happening across the country, namely the recent wave of bills that would bar minors like them from accessing gender-based care in some states.

Connor hopes teens will be spared some of the challenges he faced when making the transition long after puberty. “When I was puberty it was very depressing for me. I literally felt like my body was changing in ways that I didn’t want to,” he says.

Years later, he saw his body change again – this time in a way he wanted – as a man. It supports people making the transition as young people. “If they have parents who are really supportive of them and they are able to make the transition so they don’t have to go through two puberty, I think that’s definitely a better way to go, ”said Connor.

Increase medical options

Loren Schechter, MD – who is one of Connor’s doctors – says he too feels lucky to live in Illinois, a state where Medicaid has recently started covering gender-affirming surgeries. for people aged 21 and over diagnosed with gender dysphoria. Many Illinois private insurers also cover gender affirmation surgeries and treatments.

“I think in Illinois we are lucky. We have the state government, which seems to be quite supportive gender-affirming therapies, which, by the way, are medically necessary, safe and effective, ”says Schechter, director of the Center for Gender Confirmation Surgery at Weiss Memorial Hospital.

A recent study published in JAMA Surgery found that people who had gender-affirming surgeries were less likely to experience psychological distress and suicidal thoughts than those who had not had surgery.

Schechter says that in the past Over the past 30 years, access to care has grown dramatically for people with gender dysphoria – a medical condition that results from distress or the mismatch between who you know you are and your anatomical features.

Over the past decade in particular, Schechter believes that greater social acceptance, as well as changes in Medicaid insurance and coverage, have enabled more people to access care at an earlier age.

“The numbers have gone up exponentially, I would say, and the mean and median age has gone down,” says Schechter. He estimates that in the late 1990s and early 2000s he was performing about 20 gender affirmation procedures per year; now that number is closer to 200 per year.

Children and teenagers

In the Gender and Sex Development Program at the Ann & Robert H. Lurie Children’s Hospital in Chicago – the first complete program of its kind in the Midwest for gender non-conforming children and teens – co-director Robert Garofalo, MD, and the team see families with children as young as 4, as well as teens.

Garofalo says he and his colleagues work to promote people’s social, physical and emotional well-being of all ages. For adolescents, for example, they may prescribe puberty blockers, also called hormone blockers, that delay the onset of puberty and are reversible.

“It’s like hitting a pause button,” Garofalo says. “It gives young people and their families time to think developmentally about the next best options for them. Surgery, such as breast reduction for male patients, may also be an option for some adolescents.

Garofalo stresses that treatments and procedures are never taken lightly. Patients and their families meet with behavioral health therapists as well as primary care physicians to explore their goals in initiating any type of treatment. They are also connected to support groups.

“These hormones, our care, therapy and support groups provide a space and an opportunity for these young people or adults to live their lives as themselves,” Garofalo explains.

Connor is grateful for all the care he has found, and he is happy to share his journey with today’s teens. “I love how excited they are to see these changes happening in their bodies, especially because they get a good grip on them, as they would be going through the other version of puberty,” he says.

Plus, when they talk to Connor, the teens see a version of what might be in store for them in a few years: a 33-year-old trans man with a steady job, a wife, and a sense of gratitude for everything he’s got. lived and the care he received along the way.


Picture above: Tristan Connor. Photo by Tim Kilgore. Originally published Fall / Winter 2021 printing problem.

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