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PRIDE in Alabama Part 3: Medical Accessibility

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An APR News Feature

June is Pride month, and Alabama Public radio has spent the past few weeks diving into issues that affect the transgender community. This is the third installment of our PRIDE series, focusing on the medical accessibility for trans people of color in Alabama. That includes the risk transgender people take to get treatment.  

Hope Giselle is a trans women of color sharing her story and struggles. She’s one of several activists speaking out against the low accessibility in the medical field for black and brown communities. 

“Of course, as a black trans woman, I think that before a lot of things, people know that I am Black,” Giselle said. “When we think about the health care disparities in communities of color, and especially within black communities, we’re already at a disadvantage for what it means to be taken care of it within the health system. 

Giselle said it’s already hard for people of color living in places like Alabama to get quality health care, but she says it’s even harder for someone who is Black and transgender. The words “transgender” and “trans” are used to describe people who don’t identify with the gender that’s listed on their birth certificate. You can read more about the transgender community here.

“So, when we're talking about something that's already not considered to be a necessity or necessary, and then we bring the fact that people being black or brown into the mix, there is less likelihood that you're going to have access to it,” Giselle said.  

Giselle is the Senior Community Coordinator for Plume, an app-based hormone therapy service that also provides gender-affirming care and for transgender people. The staff at Plume is also transgender. 

Giselle said this service is needed for the trans community since medical care accessibility can be limited in places like Alabama. She said some women have to turn to extreme and unsafe measures to fund options like gender-affirming surgeries. 

“You find the lack of access really puts a lot black trans women in positions where you have a lot more people contemplating suicide,” Giselle said. “You have a lot more people concentrating sex work. You have a lot more people um doing sex work to pay for a lot of these surgeries and some of them even doing very risky things.” 

People risk "at-home surgeries, which is where we get like people pumping themselves up with things like Fix-A-Flat and expired saline or silicone and all of these things to able to get breast to create this more feminine look in order to be able to survive in society that wants to see more binary version of women,” Giselle said. 

Credit Pixabay

There are medical professionals called “affirmative providers.” That means they work with the LGBTQIA+ community and its patients. Those letters refer to anyone who is lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual. Affirmation providers also do what the title suggests. They provide support for people with gender issues. 

Affirmative providers include Dr. Sarah Mulder, a Huntsville-based clinical psychologist. She said the risk of suicide isn’t just limited to transgender adults. 

“We also know that trans youth are at an exceptionally high risk for suicide and self-harm,” Mulder said. “The rates of suicide attempts are alarmingly high, upwards of 40% among trans youth. So, treatment becomes really important to help keep these kids safe. A form of safety is making sure they’re getting the care that they really need.” 

Mulder said states like Alabama need to make medical treatment more accessible for transgender youth and teens. 

“The mind and body are connected. A healthy mind supports a health body, and vice versa,” she said. “And so medical treatment for trans youth, including hormone blockers that can prevent male puberty, as well as cross-sex hormones to create puberty that’s in line with the identifying gender, or in some cases surgeries become really important to help individuals alleviate the stress that comes from having a body that doesn’t match up with their internal identity.” 

Giselle said even when transgender people can find doctors who will provide adequate care, there are always risks involved. 

“To share a personal story, I went to school in Alabama. I went to Alabama State University, and I transitioned my junior year of school,” Giselle said. “And my doctor, who I shall keep their name anonymous, told me that they threatened to take away their medical license if they were ever caught practicing.” 

Giselle said low accessibility in medical care for trans people and the risk that comes for providers means getting creative when it comes to finding appropriate care. 

“The doctor ended up just kind of sort of having to do exactly what a lot of trans folks are forced to do, which is get on the Google, you know, do research,” Giselle said. “Talk to doctors who didn't have those issues, to still be able to provide myself and another trans man that I went to school with the life affirming the life changing care that we needed… A lot of transgender people are having to figure out where to go for this trans-affirming care.” 

Giselle said a lot of stigmas and misinformation surround the transgender community. That leads to bad biases against trans people. 

“This idea that trans people are inherently pedophiliac, right? Which we see all the time, not just in the trans population, but within the entire LGBT community where you have folks who are against this trying to push off this narrative that, you know, all of us are just like these demonic folks who want to take and feel your children… Misinformation or no information causes people to fall victim to the fearmongering,” she said. 

Giselle is calling for compassion and understanding for the transgender community from Alabamians and state lawmakers. She said she also has hopes the Biden administration will help pave the way for better health care for trans people. 

“Honestly, for the first time in a long time, I think, I feel, you know, since I haven't felt seen. And I don't think that a lot of folks within the community have felt seen since Obama,” Giselle said. “And a lot of that has been just due to the blatant racism and bigotry that have come from the Trump administration and the ways in which they decided to go about these very same issues.” 

Pride Month wraps up at the end of June, but APR will continue to provide stories on issues related to the transgender community.

Baillee Majors is the Morning Edition host and a reporter at Alabama Public Radio.
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