Coronavirus pandemic highlights barriers to health care for transgender community

The coronavirus pandemic has disrupted life for billions of people, forcing the world to deal with a sudden loss of jobs, security, and regular health care. But for those who identify as transgender, these barriers have existed for years, and advocates fear the pandemic may only make them worse. 

One transgender woman, who will be referred to as Jane out of fear for her safety, left her home in a right-leaning town along Florida's Gulf Coast for a homeless shelter in New York City so she can get better access to medical care. She's waited years to get gender affirming surgeries, and finally had two of the necessary procedures scheduled for the coming months. 

But since coronavirus started ravaging through the country, the governors of many states, including New York, have ordered hospitals to cancel or postpone elective procedures. Now, Jane's facial feminization surgery and orchiectomy (surgery to remove testicles) have been canceled until further notice. 

"Everything I was doing and progressing has been taken," Jane told CBS News. "...None of us know when this is going to be over. So we're all just sitting around. It's been torture."

Amita Swadhin, who identifies as a non-binary femme queer person, is the founding director of Mirror Memoirs, a nonprofit that advocates for and assists LGBTQ people of color who survived child sexual abuse. They said that for people living with gender dysphoria, a condition that causes distress because of the mismatch between biological sex and gender identity, getting surgery is a "matter of life or death." 

"Many of our people struggle with suicidal ideation because what they see physically on their body and how they think of themselves, how they experience their gender, is dissonant," they told CBS News. "Having those surgeries is the way to have more alignment for who they truly are."

Before Jane started transitioning, she said her life was "frozen."

"I wasn't happy. I was depressed," she said. "I couldn't figure out my greater purpose."

But now that the procedures and other health care has been put on hold, advocates say Jane and others are at severe risk of more detrimental health issues. 

Jane, who is a resident of Marsha's House in the Bronx, a homeless shelter for LGBT adults, said she is also dealing with drastically reduced access to adequate mental health care. She said the little therapy she can continue is now phone-based, making it more difficult to cope with the pandemic. That, along with the violence and uncertainty that comes with living in a shelter, she said, has worsened her PTSD. 

Swadhin explained there is a limited number of therapists who specialize in working with people of color who are also transgender, non-binary, intersex, or queer, and there are even fewer providers who are affordable and easily accessible, especially during the pandemic.

The stress that Jane is feeling because of limited access to physical and mental health care, Swadhin said, is common among the transgender community, and it takes a toll on the body. 

"Because of the way that trauma releases cortisol in our bodies, it's a lot of inflammation," they said. "It makes our immune systems more susceptible to long-term illnesses." 

According to a study published in the journal LGBT Health, transgender individuals "have more chronic conditions" than those who are cisgender and have a higher rate of asthma and chronic obstructive pulmonary disease, both of which make individuals more susceptible to coronavirus, according to the CDC.

In a letter published online on March 15, the American Hospital Association warned a "blanket directive" to cancel procedures may cause declining health and make patients more vulnerable to COVID-19. They said they support postponing surgeries if it would "not threaten the life or health" of the patient.

According to the U.S. Transgender Survey, roughly 80% of respondents who wanted transition-related surgery or hormones were denied by health insurance, and less than half of the respondents who want it have been able to receive it. 

Several health systems and hospitals have announced they will cancel such procedures for the time being. Without addressing the potential impact on transgender individuals, the U.S. Surgeon General has tweeted support for canceling elective procedures to save resources and protective equipment for the coronavirus emergency. 

For Jane and others, this latest hurdle only exacerbates the challenges they've faced throughout their lives. 

According to U.S. Transgender Survey, transgender individuals experience psychological distress at a rate eight times higher than the U.S. population, and have an attempted suicide rate that is nearly nine times higher than that of the U.S. population, with 40% of transgender individuals having attempted suicide at least once. 

Swadhin said those who are transgender are also more likely to be discriminated against when they seek health care. According to the survey, 19% of transgender people said they have been refused care because of their gender identity, and 28% say they have been harassed in a medical setting. 

"If someone is transphobic, if someone is anti-black, if someone is anti-immigrant, if someone is anti-queer, and they have to make a choice between a patient who is visibly gender non-conforming, and someone who is gender conforming ...  it actually doesn't matter whether something is scientifically sound or not," Swadhin said. "If the health care provider has that bias then that is what's going to steer their hand in the moment of making decisions."

Tori Cooper, director of community engagement for the Transgender Justice Initiative at the Human Rights Campaign, said, "Out of all the folks under the LGBTQ spectrum, trans folks are going to fare even worse" throughout the pandemic. She added, "I don't think that we can rely on the federal government to provide any protections in favor of trans folks."

In the more than 300 pages that comprise the Coronavirus Aid, Relief, and Economic Security (CARES) Act passed by Congress, there is no mention of the LGBT community. On March 31, the International Transgender Day of Visibility, the governor of Idaho signed two anti-transgender bills into law, one of which bans people from changing the sex listed on their birth certificates.  

"A lot of our lawmakers don't represent the communities that they serve," Cooper said. They represent a small part of the community, but they don't represent the fullness and the color and the vibrancy and the diversity that exists within so many of our communities across the country."   

Those who identify as transgender and who are experiencing mental health concerns can reach out to TransLifeline.org at 877-565-8860; The Trevor Project at 866-488-7386; and the National Suicide Prevention Lifeline at 800-273-8255.

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• COVID-19
• Health Care