Lisa Billings  /  AP
Zakia McKensey, right, an outreach specialist who is a transgender woman, advises a transgender client about prescriptions at the Fan Free Clinic in Richmond, Va.
updated 5/1/2006 1:17:59 PM ET 2006-05-01T17:17:59

For all the primping, powdering and pumping up many transgender men and women will do to pass as the opposite sex, there’s one thing health care experts say too many of them can’t stomach: a visit to the doctor.

A health study by the Virginia Health Department and Virginia Commonwealth University is intended to unravel the fears and prejudices hindering transgender people from seeking health care.

The Virginia Transgender Health Initiative Study targets those who feel they were born the wrong biological sex. Some undergo full transitions and have surgery; others take hormone injections to change their appearance.

Though documenting a largely closeted community is difficult, the National Center for Transgender Equality estimates as many as 3 million Americans are transgender.

Some medical experts say doctors are unschooled in how to deal with transgender patients and often are confused on everything from hormone therapy to sex reassignment surgery to the proper personal pronouns — he or she? Some are simply uncomfortable with a transgender patient, advocates say.

Transgender men and women face the standard medical issues — high blood pressure, for instance — which many of them let linger because of fear of an awkward doctor’s office visit, explained Zakia McKensey, a transgender woman and outreach specialist at Fan Free Clinic, which includes transgender services and is distributing the survey.

They also have more specific concerns, among them the need for hormonal treatment and counseling surrounding sex reassignment surgery, she said.

In those cases, fear of being made uncomfortable may push some transgender people to risky black market hormones, she said. Still others may be put off by difficulties finding doctors qualified to oversee a complicated hormone regimen, said Ted Heck, a transgender man and one of the study’s researchers.

Heck recalled his own difficulties finding a doctor for his transition.

“A friend of mine and I called every endocrinologist we could find in the Richmond area,” said Heck, who eventually had to go to Maryland for treatment. “It was pretty frustrating.”

High-risk population
The three-year outreach effort, to conclude this summer, is spearheaded by researchers at VCU and the state Health Department’s HIV planning group. It is funded by an HIV grant from the Centers for Disease Control and Prevention.

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Such grants are used to identify and help high HIV risk populations, said Judith Bradford, director of the community health research initiative at VCU.

“The process of transitioning (to another gender) puts many people at risk for not being able to have a way to earn a living,” Bradford said, explaining job discrimination leads some transgender people to prostitution and other high HIV risk behaviors to make ends meet.

The study includes an 83-question survey asking whether the survey-taker has been tested for HIV, frequency of condom use and history of rape.

Researchers also ask if a person has been denied medical treatment because they’re transgender or if they’ve ever injected illegally purchased hormones. Those questions target a bigger problem: a high-risk population that feels walled off from doctors, advocates say.

It’s in the way a physician refuses to make eye contact, they say, or calls a female-looking patient “he.”

“When we refer people out to other agencies, a lot of people kind of disrespect the girls,” McKensey said. “They see that they might not be legally changed and they refer to them as ‘sir.”’

Uncertainty and fear
Medical schools don’t often educate future doctors on sexual minority issues, explained Dr. Harvey Makadon, an associate professor of medicine at Harvard Medical school and a director at the Fenway Institute in Boston, which recently began a program to teach clinicians about those needs.

“Not everybody sees any transgender patients in their practices,” he said. “It’s something that isn’t prioritized.”

Doctors who do encounter transgender patients may grapple with an all too common emotion — fear.

“There’s just a lot of uncertainty of ... how to deal with folks,” said Dr. Mark Levine, a former family practitioner and Henrico County Health Department who attended state workshops in December on transgender health issues.

In Mara Keisling’s mind, the fact that transgender health has risen to a state concern highlights an evolving national consciousness.

“A lot has changed in 20 years for trans people and a lot, frankly, has changed in Virginia,” said Keisling, executive director of the National Center for Transgender Equality. “This is about saving people’s lives.”

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