Read Advisory Board's take: 2 imperatives for providers to support transgender patients

Transgender patients "still struggle to find competent basic care, much less trans-specific care," and the Trump administration's recent proposed rule threatens to return the trans community to a health care environment that can deny them care, Katelyn Burns, a freelance journalist who is transgender, writes for Vox.

A prescription pickup that resulted in 'humiliation, anger, and embarrassment'

Burns recalls a time early in her transition when she went to pick up her prescribed hormone replacement therapy at the pharmacy with her two children. At the time, Burns writes her children didn't yet know "the person they thought was their dad was actually a woman."

When she reached the speaker at the drive-thru, the pharmacist said, "Sir, do you understand what these medications are for?" When Burns explained that she understood and said the medication was prescribed to her, the pharmacist stated, "Sir, these are female hormones. For women," Burns writes.

After explaining that she had gender dysphoria, Burns was met with "a long pause on the other end."

The pharmacist then told Burns, "Sir, we canceled your prescription because we couldn't figure out why a man would need female hormones. You'll have to have your doctor call us to confirm this is correct because it doesn't make any sense."

Burns writes that in that moment she felt "[h]umiliation, anger, and embarrassment …  and tears quickly began running down my face."

Overall, the interaction was "a reminder that being trans is still not a comfortable concept in our society," Burns writes.

All too common

Unfortunately, situations like what Burns experienced at the pharmacy are "all too common in the U.S. health care system," she writes.

Weeks ago, the Trump administration announced plans to roll back gender identify nondiscrimination protections in the Affordable Care Act, which protected transgender patients against discrimination, Burns writes. However, even with the protections in place, Burns writes, "discrimination against trans people ran rampant in the health care system."

According to Burns, one-fifth of all transgender patients said they received unequal treatment from clinicians. The inequalities, Burn writes, can stem from a "lack of knowledge on how to address trans people."

For instance, some health systems do not allow patients to use their preferred pronouns or non-legal name at medical facilities. In other cases, doctors' assumptions about transgender patients' bodies can leave transgender patients responsible for explaining to clinicians how they should go about providing them basic care.

Burns recalls one interaction with an urgent care nurse when she sought treatment for a urinary tract infection (UTI), "which I had had before and was familiar with."

The nurse asked her how she could "be sure it's a UTI" and "not vaginal discharge."

"Because I don't have a vagina," Burns responded. Burns recalls that the nurse "grew visibly uncomfortable" upon her response and continued to doubt that Burns had a UTI. The nurse eventually brought in the doctor who Burns writes "began asking me detailed questions about my sex life in front of my children," assuming she had a sexually transmitted infection. "I had to beg the doctor to order tests on my urine sample and prescribe me an antibiotic, which she eventually agreed to," Burns writes.

Transgender patients lack access to care

These experiences caused Burns, who is insured, to question what navigating the health system must "be like for those with even less access to insurance and the health care system at large" she writes.

A 2015 survey from the National Center for Transgender Equality revealed that 13% of transgender people in the United States are uninsured, compared with 10% of the general population. And this number might be grow, Burns writes, as the Trump administration's proposed rule would again allow insurance companies to exclude transition-related coverage on a wide scale.

In addition to barriers to transition care, transgender patients still "face a daunting lack of compassion and knowledge from the wider medical community," according to Burns. For instance, Burns says "trans broken arm syndrome —a phenomenon where every little ailment, from an infection to a broken arm, is blamed on the hormones …  is a common occurrence within the medical community."

And while more medical providers are undergoing training to better treat transgender patients, Burns writes that transgender patients still struggle to find decent basic health care, let alone care that is specific to transgender patients.

"We all have basic health care needs beyond just hormones and surgery. Yet doctors and other health care providers simply don't expect trans bodies in their practices," she writes (Burns, Vox, 6/21).