Transgender teens in Arizona face multiple obstacles when trying to receive adequate and knowledgeable health care.
A lack of resources, combined with a lack of awareness of those resources, creates a difficult system to traverse. Some parents have taken it upon themselves to map out this nonexistent network that includes finding a counselor, pediatrician and surgeon who can help their transgender children transition.
The central theme to every coming-of-age story is an adolescent’s search for his or her place in the world — or the “authentic self,” as described by one mother of a transgender teen who wished to remain anonymous. For many transgender teens, time is essential.
This mother, who holds a Ph.D. and works as a research professor at the University of Arizona, struggled to find the right health care when her son came out as transgendered at the age of 15. “From the very start he said, ’I want the surgery’ ” she said. Thrust into a world where one has to understand the intricate concepts of gender and sexuality, she scoured the Internet and created a network of friends and professionals who could assist her and her son. “It was a transition for all of us,” she said.
“Just give it a few years,” was the common response when it came to acquiring resources at the beginning of the process, she said. But “you’re sitting here with these young kids and they don’t really have a few years to be in high school as their authentic self,” she said.
Dr. Russell Toomey, a UA assistant professor in Family Studies and Human Development, who specializes in research on LGBT youths, can attest to the necessity of timeliness.
“We know that when youth do receive adequate treatment and affirmative care and they’re able to transition, [there are] many positive effects on their overall thoughts and well-being.” Before her son transitioned, the mother described him as a young boy whose disconnect from his identity and body was beginning to wear on him physically and mentally.
According to Toomey, transgender individuals in the U.S are more likely to be homeless and face problems with employment, education and health care. Though there is no concrete data on teen transgender health care, Toomey said, receiving care specific to their needs and insurance coverage is difficult.
Policies can vary. For example, Toomey states that health insurance through the UA has an exclusionary policy that is vague and broad. “Any treatment or related condition to transgender-related mental disorders will not be paid for,” and that’s for any trans-identified employee as well as dependents, he said. Toomey called it a big disconnect because UA’s student policy covers surgery and hormones.
When the UA professor found a pediatrician who would administer hormones to her son, she said UnitedHealthcare agreed to cover the therapy after an appeal filed by the pediatrician’s office.
Hormones are becoming more accessible through insurance providers, are relatively inexpensive and last for a long time. Where policies begin to get murky is when insurance companies attempt to define whether surgery is “medically” necessary for transgendered children.
As compared to others in their age group, Toomey said “transgender youth experience very high levels of rejection from their families when they disclose their gender identity to their parents. We also know in addition to that that they experience very high levels of victimization at school from their peers as well as from their teachers,” he added.
In theory, if a transgendered teen has parental support and the insurance coverage necessary to cover medical costs, the next step is finding surgeons, physicians and counselors locally that understand and are sensitive to the youth’s needs.
Finding physicians in the Tucson area is usually through word of mouth, the mother said, and it often takes a counselor to write a letter to a pediatrician for hormones to be administered to youths under the age of 18. A wrong physician who is insensitive or lacks understanding of transgender youths can prove to be detrimental and slow down the process significantly.
Teens who receive clearance from a mental health professional and wish to stay in Arizona to complete their surgical procedures may find less than five doctors available statewide to operate on them under age 18, Toomey said.
Dr. Eric Plemons, a medical anthropologist at UA who specializes in the area of transgender medicine, credited the lack of surgeons to a reshaped “trans-political” discourse, which has removed the surgical aspect of transitioning from the conversation.
Many doctors have moved to exploring “identities, potentialities, affinities and feelings of sense,” as it relates to transgender identities, Plemons said. He said standards of the best practice models of wellness and care have grown from an 11-page document to 114 pages because it now includes “wellness, sexuality, and family relationships.”
As a result, “very little attention (is being) paid to the practice of surgery,” Plemons said.
“The number one reason why there are so few [surgeons] in Arizona and across the country is because it is not required for medical schools to talk about LGBT issues in general,” said Toomey, adding there is little attention paid to the transgender population.
The medical infrastructure, Toomey said, doesn’t accommodate surgeons who wish to specialize in transgender procedures. Most go abroad to get training, which can be expensive and deterring, he said.
“It’s not part of their educational experience when they’re learning how to be a surgeon or even just a primary care physician,” Toomey said.
Even surgeons who can complete the transgender procedures tend to stay away from people under the age of 18 for various reasons, including fear of lawsuits, Toomey said. But the fear that a child will change his or her mind about being transgender after surgery is not supported by facts, he said.
Trying to interact with plastic surgeons in Arizona who do transgender surgeries, the mother found that most are located in Scottsdale and that they don’t have a clear or easy-to-find policy on operating on teens under 18. It took numerous calls and persistent dedication, she said. When she did find a surgeon in Arizona, she said the wait for a consultation was six months, and the wait time to get the surgery could be two years.
With her son’s mental health at stake, she realized the only option was a private surgeon based in Colorado. The doctor doesn’t accept insurance, so he is inaccessible to many, she said.
Nonetheless, years of savings the family had put away allowed for her son to receive the surgery and return back to a local, trans-friendly school, much happier than before, she said.
The experience led her to be more active within the Tucson community, and she now participates in the Southern Arizona Gender Alliance’s (SAGA) Trans Parent Support Group group. She advocates that there is a market and a need for surgeons and physicians that care for transgendered teens in Tucson.
A core group of families, from single fathers and working mothers, along with a portion of the latino community that attend the group she says, simply seek and call for adequate and accessible medical care for their children. Camaraderie is key as each embark on their own transition.
Sydney Haliburton is a reporter for Arizona Sonora News, a service from the School of Journalism with the University of Arizona. Contact her at shaliburton@email.arizona.edu.