Op-ed: A Haven for Trans Health in Upstate New York

Transgender people face difficulties when it comes to health care. Seventy percent of transgender patients have experienced discrimination when seeking health care, and one in four have been denied care. They are more likely to be uninsured, and even if they have health insurance, their plan may not cover transgender health services. For people living in rural areas, where resources are scarcer, these issues can be even more pronounced.

Ithaca is an isolated community in upstate New York. Since 2009 it has been home to Out for Health, the local Planned Parenthood's LGBT Health and Wellness Program. When the program opened, Planned Parenthood of the Southern Finger Lakes commissioned research to better understand the barriers to care for LGBT people in the area, including what made rural LGBT people feel excluded or included as they sought health care.

Among the key findings of that research was the stark absence of care and resources for transgender people. We heard stories of transgender people driving eight hours round trip to Philadelphia to receive routine preventive health care and hormones to support their transition. We knew we needed to do something to address this need.

In fall of 2011 a small group of committed PPSFL staff, with extensive consultation and feedback from members of the local transgender community, began the process of creating new services for transgender patients to be available through Planned Parenthood in Ithaca. The transgender preventive care and hormone program opened its doors in the winter of 2013 and offers access to care, hormones, information, and support for transgender people in rural upstate New York. Although Planned Parenthood nationally has health centers from Santa Cruz, Calif., to Billings, Mont,, and Barre, Vt., offering transgender services, PPSFL, with its Out for Health program, is New York State's only Planned Parenthood offering these services. The program has also created a fund for transgender patients if they need financial help in order to get health care at the center.

Luca Maurer had been a patient at Planned Parenthood in Ithaca for more than 20 years. Maurer, like many transgender people across the country, had struggled for years under the day-to-day lived reality of transphobic policies and practices, had been stigmatized and discriminated against by health providers, and had all but given up on the hope of having access to transgender care. When he learned of the new transgender health program in his community, he hoped it would be a place for him to receive welcoming care as a transgender man.

"I knew what I wanted and needed, and my provider listened to me, trusted me, and supported me fully in making the decision that was best for me," says Maurer. At the age of 49, he was able to learn more about hormone services in discussions with his provider. In a collaborative health care process, they worked through his questions and came to a decision that worked best for Maurer.

Calvin Kasulke was a brand-new patient at Planned Parenthood when he began his care through the transgender health program. Twenty-two and newly out as transgender, Kasulke was struggling with limited family understanding and support, which meant access to health care was difficult. Planned Parenthood's program gave him access to caring, nonjudgmental providers in a time of great need. "I could get care and access to hormones without being required to jump through cost-prohibitive and time-consuming hoops. My provider trusted me as I explained my circumstances and my desire for hormones; that was excellent," says Kasulke.

Kasulke's trust and comfort with the Planned Parenthood provider led to his decision to get a Pap test at the health center. He shared, "Tania was very respectful of my feelings about the exam and was very intentional in asking how she could best go about it to suit my needs. I don't think I would've gone through with getting one -- possibly ever -- if I wasn't certain my doctor was knowledgeable about and comfortable with my identity as a trans man."

Maurer's and Kasulke's experiences led them to be among those nominating PPSFL's Transgender Health Services Clinic for an Achievement Award from the Gay and Lesbian Medical Association, which recognizes outstanding contributions and exemplary commitment to improving the quality of health services for LGBT people.

Physician assistant Tania Villa and I were honored at the awards gala earlier this month for our work in establishing the program.

Maurer's nomination recognized "their drive and dedication, alongside their entire team of Planned Parenthood colleagues, to create supportive, welcoming, and inclusive spaces for transgender and gender nonconforming people in which their critical health needs can be met -- one in which transgender people are acknowledged, respected, and valued."

Kasulke's personal reflection stated, "[This program] has literally changed my life, and I know it's changed the lives of other people in the area. There is nothing like it anywhere in the area. We are very isolated here and didn't have any transgender healthcare before, unless a person could get to one of the major cities (which are all very far away, like Philadelphia, or New York City, or even further).

"The informed consent model they use respects patients and treats us like we are fully human and capable of making decisions about our own bodies and health, really different from some other experiences I've had. All the nurses and doctors I interact with during my visits are friendly, helpful, caring, and kind. They answer my questions and don't discriminate against me because of my identity. I don't know what my life would be like without what Maureen and Tania have made here."

This program's commitment is simple: to meet previously unmet health and preventive care needs of transgender people in New York State. Sadly, many of our patients were previously not receiving care at all or traveled very long distances in order to access care. We are so proud to be able to provide local care and services to transgender people in the Ithaca area. We hope the caring services provided here can counter the far-too-often negative experiences that transgender people face when seeking health care.

Removing barriers to health care for transgender people is critical no matter where they live, whether in urban, suburban, or rural communities. As a queer woman and a Planned Parenthood provider, being able to be a resource in my community -- for me it shows the links between LGBT rights and the reproductive justice movements. We have so much more we can do - and I'm excited to see where we go from here.

MAUREEN KELLY is the vice president for programming and communications at Planned Parenthood of the Southern Finger Lakes and founder of the Out for Health program. PPSFL's LGBT Health and Wellness Program, Out for Health, provides outreach, education, and advocacy to LGBT people, their health care providers, and the community at large about the importance of inclusive, welcoming, and respectful care for LGBT people.