The Lack of Trans-Friendly Doctors in the South Is an Injustice

In the past year, an estimated 115,000 trans people who live in Southern states didn't seek out health care when they needed to because they were afraid of mistreatment from their medical providers.

That's what current data tells us. According to research by the Williams Institute, more than 500,000 transgender folks call the South home, and the U.S. Trans Survey found that 23 percent of trans people report not seeking health care services because they don't trust medical providers to provide them with competent care. That means last year, 115,000 trans Southerners did not get the health care they need.

Let's take a minute to let that sink in and imagine the real faces of the people left vulnerable. These aren't just numbers; these are real people, with real health care needs. We are your friends, parents, children, coworkers, teachers, and preachers - and the change we're seeking in healthcare is acute and urgent.

I'm grateful to have had the chance to hear the intimate, often painful stories from dozens of trans and non-binary people from across the South through the Southern Trans Health Focus Group Project, a project of the Southern LGBTQ Health Initiative from the Campaign for Southern Equality and Western North Carolina Community Health Services. Through this project, nearly 50 trans and non-binary participants in six states shared candid stories about their experiences accessing health care services.

The findings from this project aren't just about the numbers either. Instead, the report documents the real, hard-to-quantify experiences of what it's like to access health care as a trans person in the South in 2018.

The primary lesson that has resonated with me since having these conversations with folks is the influence of both trust and community.

Trust: It's supposed to be the foundation of our relationship with our doctor. Sure, we may do a little research on our own, but on the whole, when the doctor tells us to do something because it's right for us, we don't usually question it as being right (even though we may still occasionally indulge in that pizza or neglect that amount of cardio they suggest). We trust them, and we believe that what they're telling us is true.

For many of the trans folks we spoke with through the Southern Trans Health Focus Group Project, that trust is not so implicit. From their very first interactions sharing their gender identities with their doctors, many of the participants expressed having to prove to their provider that they were masculine enough or feminine enough or had felt this way long enough to actually know what they want for their own bodies. There is relentless pressure to meet the care providers' expectations. The general understanding is that if you present a certain way, talk a certain way, answer all of the questions about your identity a certain way, then maybe - maybe! - the doctor will give you the care you need and deserve.

This is the shaky foundation that many trans Southerners are dealing with when it comes to their health care decisions - and it's because there are too many health service providers who don't have the resources they need and too many front office staff who don't have access to basic education about respecting everyone's names and pronouns. When you add into the mix intersecting identities like being poor, coming from a rural area, or being a person of color, those barriers to accessing competent care compound exponentially.

Health care providers' lack of education often presents a real potential for physical danger. One participant reported being prescribed the wrong medicine because of a lack of education on the part of the physician. And many participants were addressed by the incorrect name or pronouns, leading to them being outed as trans to the entire waiting room.

Many of the stories we heard while conducting this groundbreaking research were hard to listen to, because I know they represented the experiences of thousands of trans and non-binary Southerners. However, in the midst of all of this pain, I also saw something truly beautiful: No matter what city or town we were in and no matter how robust or lackluster the resources in that area were, every single time someone expressed that they were having a hard time finding a provider, other participants stepped up and started sharing resources with each other. No one left a focus group without knowing that they could access care and that they had the support of the people around them.

The struggle to find a competent and friendly care provider is a shared experience among so many trans and non-binary Southerners. That's why the Campaign for Southern Equality has just published a new update to Trans in the South: A Guide to Resources and Services, a directory of 400+ providers across 13 Southern states. It's the fourth edition we've published since 2016, and the number of providers listed has more than doubled in that time. This tells me that our efforts to change this system are working. Our connection to more resources is strengthening. Our access to competent care is increasing.

Hearing the dreams and seeing the work of trans leaders across the South to build programs that offer wraparound care services designed specifically by trans people for trans people fills me with great hope. The leaders we spoke with are already getting their people tested, connecting them with care providers, serving as emotional support, and empowering them. All of this adds up to many positive outcomes for folks' health.

Trans leaders - and our many allies - are redefining what trans health means in the South. They are transforming this resource desert into a South where any trans person of any age, race, or socioeconomic status in any town is able to access a care provider who will treat them with dignity and respect. All of these things give me hope, but what gives me the most hope is seeing it reflected back in these trans people's eyes.

IVY GIBSON-HILL (they/them/theirs or ze/hir/hirs pronouns) is the Director of Community Health Programs for the Campaign for Southern Equality and the Executive Director for Gender Benders.