Nathan Rodriguez lives two hours away from his doctor in Somerset County. Although he has to take a full day off work to make the four-hour round trip from his home in Atlantic County, Rodriguez, a transgender man, said it's worth it.
“I go to this practitioner because she knows a lot about the trans community,” said the executive director of the Trans Equity Coalition, a nonprofit organization run entirely by trans and nonbinary people. director Rodriguez says. “She stopped me from taking medications and things like that that negatively affected my hormones. So I'm going to go to someone who knows.”
Obtaining medical care in the United States can be difficult for the average person, according to experts, doctors, and academics who spoke to NJ Advance Media. It's even more difficult for transgender and non-binary patients. .
Although New Jersey is considered a safe haven for LGBTQ+ health care, transgender and nonbinary people face barriers to even the most basic physical and mental health care, let alone gender-affirming care. continues to face. In addition to the challenges we all face when accessing health care (securing adequate insurance, rising costs, transportation), transgender and nonbinary people face knowledge gaps, according to first-hand experience. , say they face discrimination, harassment and fear of physical assault.
The COVID-19 pandemic has exacerbated existing challenges, reduced access to gender-affirming resources and increased mental health risks, according to research from the South Jersey Population Health Institute. A survey of more than 200 trans and nonbinary individuals living in South Jersey found that 21% of trans men, 28% of trans women, and 58% of nonbinary respondents had experienced severe depression. and severe mental health issues have been revealed.
Communities also reported high rates of anxiety, with 29% of participants saying “fear of discrimination by health care providers” was the main barrier to attending medical appointments. said.
“Barriers to general medical appointments and mental health personnel are seen among transgender and non-binary people, in addition to the lack of access to gender-affirming health care providers who may already have access to gender-affirming health care providers. They have confidence in their health care provider and feel like they can trust their health care provider,” said Dr. Christina Goodwin, assistant professor of psychiatry at Rowan University's Cooper School of Medicine, who worked on the study.
“I think anxiety comes from not being accepted for who you are: being misgendered, anonymous, or not respected by your mental health provider,” Goodwin said. say.
Despite the majority of respondents having health insurance, financial barriers are found to be the primary barrier to attending medical appointments for transgender and non-binary people living in South Jersey did.South Jersey Population Health Institute
The real or perceived threat of discrimination can prevent transgender people from receiving medical care when they need it.
A national survey of 93,329 binary and non-binary transgender people found that many respondents avoid seeking medical care due to fear of discrimination. The 2022 U.S. Transgender Survey found that nearly one in four respondents did not seek medical attention when needed in the past 12 months due to fear of abuse.
Rodriguez said she avoided treatment for complications she experienced from a hysterectomy she had out of state because of several bad experiences at urgent care facilities near her home in South Jersey. Ta.
“I came in in a very masculine manner and was going to say, 'I just had a hysterectomy and I'm having some complications,'” said Rodriguez, who takes testosterone. Ta. “I just suffered through it. I decided I wasn't going to subject myself to anything like that.”
Fear of discrimination is well-founded. According to the U.S. Transgender Survey, 48% of respondents who visited a health care provider in the past 12 months reported being refused medical care, being misgendered, or being misgendered by a health care provider because they are transgender. reported at least one negative experience, including being harshly or verbally abused by someone. when treating them or if the health care provider is physically rough or abusive when treating them;
Even if a provider unintentionally uses a dead name or accidentally uses the wrong pronouns, such as calling a transgender person by their real name instead of their chosen name, it can be harmful at best. , which in the worst case can cause damage.
Aisling MacDonald, a transgender woman and project manager and trainer for Garden State Equality, said: “When dead names pop up, when gender misidentification pops up, there is a lack of safety. “It immediately creates an environment where there is a perceived or actual threat of harm.” The state's largest LGBTQ+ advocacy and education organization.
“Do you believe that my provider is trying to take my life five minutes into the session?” McDonald asked. “I don't think so. But do you immediately feel like this is not a place where you can get the care you need other than life-saving gender-affirming care? Yes.”
People with a gender identity or expression that differs from their assigned gender may have to travel several hours to see a health care provider who is openly LGBTQ-friendly and trained in best practices.
Although New Jersey has LGBTQ+-affirming health care providers throughout the state, the majority are located in the North, where the majority of the population and major health care facilities are located, according to Garden State Equality's Affirmative Care Map. concentrated in Jersey.
For example, Robert Wood Johnson University Hospital Somerset is one of only two hospitals in New Jersey that performs “bottom surgery,” surgery that adapts a person's genitals to match their gender identity. The hospital is one of the few in the Northeast. Hospital website.
“Yesterday, we had a patient that we referred to who lives just down the coast,” said Dr. Justin Schweitzer, medical director of the LGBTQ+ Health Center at Cooper University Health Care. “Talk about access to care. Even though we are probably one of the most densely occupied states in our country, we still have problems with access to care.”
Treating transgender patients may be new territory for many physicians. Almost 1 in 4 transgender adults who responded to the 2015 U.S. Transgender Survey reported a need for clinicians to teach them about transgender people.
“I applied for a hysterectomy, and the person who made the appointment over the phone kept saying, 'Okay, then ma'am,' and I was like, 'No, that's for me.' said Jason Wilkerson, a transgender man and volunteer. Trans Equity Coalition. “She said, 'I'm not in the mood for jokes,' and hung up.”
Wilkerson said she had to call back the office and explain to another person that “I'm transgender.” I have a vagina. ”
“They were like, 'Sorry, we thought it was a prank call,'” Wilkerson said.
This experience can be alienating and frustrating for transgender patients. The 2015 U.S. Transgender Survey found that people who had to teach their clinicians about transgender people were more likely to have poor self-rated health and severe mental health problems than those who did not have to teach their clinicians about transgender people. It was found that the level of distress was significantly higher.
“As a transgender individual, being asked to tell your provider how to best support you is pretty demeaning,” said Lucas Manrique, project manager and trainer at Garden State Equality. spoke.
All of these obstacles exist in a state considered one of the most welcoming states for transgender people. Last year, Gov. Phil Murphy granted gender-affirming protections to adults and minors and authorized the extradition of individuals in New Jersey to other states for the provision, receipt, or promotion of gender-affirming health care services. He signed an executive order banning it. The state also has strong anti-discrimination laws that protect sexual orientation and gender identity in a variety of situations, including employment, housing, and public accommodations.
State Attorney General Matthew Platkin sued the school district, accusing it of violating state discrimination laws and adopting policies that put gender nonconforming students at risk.
Thirty-two New Jersey hospitals have been named 2024 LGBTQ+ Healthcare Equality Leaders by the Human Rights Campaign Foundation, the third most in the nation.
But transgender people, medical professionals and experts say more can be done to ensure healthcare is accessible, welcoming and affirming for transgender patients. Advocates say it's especially important amid nationwide concerns that President-elect Donald Trump will roll back transgender rights.
Schweitzer said health care providers can go the extra mile and train more full-time employees on how to provide LGBTQ+-affirming care.
“In my lectures, we talk about pronouns and definitions, but we also talk about why they're important. So we talk about health disparities and the particularly high risk of suicide among transgender youth. We talk about HIV risk and , we talk about how trans women of color are at higher risk,” Schweitzer said. “Think of this as a life-saving medical treatment, not just a pronoun.”
The Trans Equity Coalition also provides training to doctors on how to treat transgender patients and teaches them how to practice inclusively.
“Despite all the effort I've put in, the results aren't great, so I want to continue to improve,'' Rodriguez said.
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Contact Jackie Roman at jroman@njadvancemedia.com.
