Not every transgender person seeks a medical transition. Surgery is financially unreachable for many. It can be medically contraindicated for some. And some just do not desire it or find it to be necessary to living a fulfilling life.
But those who do seek a surgical transition encounter a major problem.
TSSurgeryGuide.com lists fewer than 30 physicians who offer sexual reassignment surgery, mostly located on the coasts.
While a few more surgeons might not have been listed, that number is probably in the ballpark, according to medical professionals who told America Tonight that people who are transgender are dangerously underserved by the medical system, especially when it comes to surgical specialties.
I remember getting a phone call in my office on day from the chief of surgery, who was screaming at me on the other end of the line, saying – and I’ll never forget this – he said, ‘Don’t you even think about bringing those freaks into my hospital!’ So, that’s what I was dealing with when I started this.
Taylor said medical school and his surgical residency didn’t offer him any training in gender dysphoria and the related surgical issues. Twenty years ago, his practice took a turn after a psychologist friend asked if he’d be willing to see transgender patients in need of surgery.
I started researching it and became more interested in it, and started to really kind of develop a passion for these patients. God has given us the ability to treat disease, whether it’s high blood pressure, diabetes, whatever. You know we have the knowledge and the capability to treat it, so why not gender identity?
[It’s] a lot of learning. [There’s] no textbook with this information in it,” he said. “You won’t find it. You won’t find it anywhere.
Until last year, people who wanted surgery had to pay out of pocket – roughly $7,000 to $24,000 for male-to-female or possibly more than $50,000 for female-to-male. But changes to Medicare and the Affordable Care Act now allow for some insurance coverage of these procedures.
I stopped counting how many calls I got from people in the greater metropolitan area.
We really don’t have a system set up to meet how much need there really is. There’s a far greater need than there are … people available to do it.
--Dr. Barbara Warren, Mount Sinai Health System, NY
Word of a second crisis filters out from the left coast. This one centers on medical treatment for trans youth.
But there is a huge disparity when it comes to available transgender medical care. With no reliable data on how many trans people are in the U.S., the health-care community is not prepared to provide adequate and appropriate trans-related services for those in need. Children’s Hospital Los Angeles has the only dedicated clinic for transgender youth in Los Angeles. San Francisco, Chicago, Boston and a few other large cities have centers, but in most other places around the country, there’s a dearth of providers. After Caitlyn’s Diane Sawyer interview, a parent of a young transgender child in the Midwest called me looking for help and a referral. Unless a family can get to one of the few existing centers, there’s practically nothing in the way of services available. Sometimes this is true even for people within 50 miles of our center.
--Dr. Johanna Olson, Children's Hospital of Los Angeles
Most people who posit ethical issues with early intervention aren’t actually working with gender-variant or transgender youth. They aren’t sitting with these children and their families witnessing what they’re going through. Transgender-youth care is undertaken with thoughtfulness. Most of the young people who are going on blockers have been in care for a considerable amount of time with a mental-health professional. There’s an implication that we, as medical providers, don’t consider the ethical issues that arise. Standing around and watching a child suffer when we have proven, safe means to intervene — that’s unethical.
Unlike in other areas of medicine, providers are allowed to opt out of gender-related care, citing personal beliefs. We don’t allow physicians to refuse diabetes care because they don’t believe in treating diabetes. This lack of medical and mental-health services for trans people is a crisis that continues to result in significant negative outcomes, including isolation, homelessness, unemployment, HIV and suicide.
There’s a predominate misconception that the worst possible outcome for a human being is that he or she is transgender. Skeptics are critical of early intervention, asking the question, "What if they aren’t transgender, and they’ve undergone hormone treatment?" Every trans individual’s story and experience is unique, so great care and consideration is taken by providers who specialize in this extraordinary field of medicine.
How do we solve these crises?
Legislation can help with resource allocation. Philanthropy and grants can help fund direct care and research. Formalized medical and “culture competency” training is critical for educating providers about the trans experience and that medical intervention is a necessity. The first step for the medical community is learning how to use correct names and pronouns and to treat transgender people with dignity and respect.
I’m just hoping that we see more of the scientific community coming out and studying this more from a biological standpoint. I hope that the medical community really does embrace it.